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You deserve a comprehensive eye exam!

What really is a comprehensive eye exam?

A comprehensive eye exam to assess your visual system and eye health involves several different tests. Unlike a simple vision screening, which only assesses your vision, a comprehensive eye exam includes a battery of tests in order to do a complete evaluation of the health of your eyes and your vision.

A comprehensive adult eye examination includes:

  • Patient and family health history.
  • Visual acuity measurement.
  • Preliminary tests of visual function and eye health, including peripheral (side) vision and the response of the pupils to light.
  • Assessment of refractive status to determine the presence of nearsightedness, farsightedness or astigmatism.
  • Evaluation of eye focusing, eye teaming and eye movement abilities.
  • Eye health examination. (slit lamp exam, tonometry, & dilation)

Patient and family health history

Systemic diseases such as diabetes, hypertension, or autoimmune diseases affect the entire body and the eyes are no different. This is why we ask comprehensive medical history such as conditions and current medications that you are taking at your exam. It is important to know family history as well. There is an increased risk for developing many conditions such as glaucoma, macular degeneration, or keratoconus if it runs within your family.

Visual Acuity Measurement

Visual acuity is a measurement of your vision using an eye chart, the Snellen Eye Chart. In this test the patient is seated at a standard distance and is asked to read letters or symbols of various sizes, which get smaller as you move down the chart. The results are the familiar ratio of 20/20, 20/40 etc. which is a comparison of your vision compared to the average person with good vision, which is typically 20/20. For example, a patient that has 20/40 vision, can only see at 20 feet what the normal person can see from a distance of 40 feet. This test is a preliminary test of how clearly you are seeing in each eye but it does not give you a prescription for corrective lenses.

Preliminary tests

Preliminary tests give us an in-depth view into your visual function besides just your visual acuity. For example if your pupils are not responding to light correctly it can lead us to suspect neurological dysfunction or optic nerve dysfunction.

Refractive status

This is the dreaded “1 or 2?” portion of the examination. Refraction provides us with the lens power that best corrects your refractive error determining whether you are near-sighted, far-sighted, or have astigmatism. This is how we assess the best possible prescription for your eyes.

Eye Teaming

To see a clear, single image, the eyes must effectively change focus, move and work in unison. An assessment of ocular motility, and binocular vision determines how well your eyes focus, move and work together. This testing will look for problems that keep eyes from focusing effectively or make using both eyes together difficult.

Eye Health

The final and most important aspect of a comprehensive eye exam is a check of your overall eye health. Various tests are done to identify any eye conditions or diseases, both inside the eye as well as the external parts of the eye, that could affect your vision and general health.

Slit Lamp Exam

The slit lamp or biomicroscope is an instrument that allows the doctor to examine the internal and external parts of the eye in detail, such as the conjunctiva, iris, lens, cornea, retina and the optic nerve. The patient rests their forehead and chin on a headrest to stabilize the head, while the doctor looks into the eye with the slit lamp microscope, which is magnified with a high-intensity light. A slit lamp test enables the doctor to evaluate the eyes for signs of normal aging and eye pathology, such as conjunctivitis, cataracts, macular degeneration or retinal detachment. Early diagnosis and treatment of eye diseases are essential for preventing vision loss.


Tonometry is a test measuring the pressure inside your eye or IOP (intraocular pressure). Elevated IOP is a risk factor for glaucoma. Glaucoma can cause vision loss and even blindness if the IOP in the eye is too high and damages the optic nerve.

At Fuerste Eye Clinic we use iCare tonometer which uses rebound technology off of your tear film to measure your IOP. This allows us to measure your pressure without requiring numbing drops prior.

Pupil Dilation

This is arguably the most important aspect of your eye exam. The pupil without dilation constricts when the light from the slit lamp is near causing a limited view into the back of the eye. With a limited view it is much more difficult to assess for various diseases such as cataracts, glaucoma, macular degeneration, and retinal tears or detachments. Dilation drops keep the pupil from constricting to light allowing a window to view the posterior segment of the eye.

Typically, the drops take around 10 to 15 minutes to take effect and may last up to several hours following the exam; each patient is different. Since more light enters your eyes when your pupils are dilated, you will be more sensitive to bright light, especially sunlight. Dilation also temporarily paralyzes your ciliary body muscle so younger patients may experience blurry vision when looking at things close to them such as a cell phone. Although your doctor may provide disposable sunglasses, you may want to bring a pair of sunglasses to wear after the exam to make it more comfortable until the drops wear off.

A comprehensive eye exam is an important part of your overall general health maintenance and should be scheduled on a regular basis. The findings from your comprehensive eye exam can give your doctor important information about your overall systemic health. An eye exam is much more than just getting glasses!

We welcome the opportunity to help you care for your vision health and optical needs.
For appointments, contact Fuerste Eye Clinic in Lancaster (888) 582-0769.

Tyler Risma, MD

Luke Ploessl, OD