Comprehensive Eye Examination

A comprehensive eye examination includes thorough anatomical and functional assessments designed to provide an overall evaluation of eye health. Compared to a routine eye exam, the comprehensive ophthalmological examination is far more detailed and is supplemented with additional instrumental tests tailored to the patient’s complaints to ensure an accurate diagnosis. Its goal is to establish the most precise diagnosis, based on which the most appropriate treatment plan can be developed.

To ensure a thorough assessment, we administer pupil-dilating drops so that the pupil enlarges and the ophthalmological examination becomes more optimal. Thanks to pupil dilation, deeper parts of the eye that would otherwise not be visible also become examinable. In addition, the central areas of the fundus (macula, optic disc, vessels) can be examined in much greater detail and in three dimensions, which plays a key role not only in establishing the diagnosis but also in differentiating between various diseases.

When Is a Comprehensive Eye Examination Necessary?

In all cases where the patient’s symptoms may be characteristic of multiple ophthalmological conditions, it becomes necessary to perform a comprehensive eye examination. For example, if someone complains of blurred vision, it may be caused by dry eye, but it could also be caused by cataracts or macular degeneration, the precise diagnosis of which requires a dilated eye examination supplemented with an OCT scan.

On the other hand, in simple cases of ocular surface infections, during allergies, minor superficial foreign bodies, or a stye appearing on the eyelid, a comprehensive eye examination is not necessarily required. However, the patient should be aware that since such a thorough examination has not been performed, the presence of other ophthalmological abnormalities cannot be ruled out.

In certain diseases, a comprehensive eye examination cannot be performed (for example, in the case of vitreous hemorrhage, fundus examination is not possible), or cannot be performed in a single session (for example, in the case of a surface infection, we do not measure intraocular pressure). In such cases, we call the patient back for a follow-up examination, when, in addition to repeating the previous tests, we attempt again to perform the omitted examinations.

What Does a Comprehensive Eye Examination Include?

During an eye examination, we never routinely perform every existing ophthalmological test, only the general eye examination. However, in certain conditions, it is important to examine every part of the eye thoroughly using other methods as well, in order to obtain the most comprehensive picture possible. Consequently, the comprehensive eye examination of two patients may differ from each other, as the indicated supplementary procedures are personalized.

Components of a General Eye Examination

• Examination of the external parts of the eye (e.g., eyelid)
• Corneal curvature examination (keratometry)
• Determination of objective refractive errors
• Subjective visual acuity testing for distance and near
• Preliminary examinations*
• Intraocular Pressure Measurement
• Slit-lamp examination**

In certain cases, based on the patient’s complaint or medical history, it may already be known what supplementary tests will be needed, such as a visual field test for a glaucoma patient or an OCT scan for a patient with macular degeneration.

Supplementary Ophthalmological Tests

• OCT Examination
• Visual field examination
• Ultrasound Examination
• Lens Calculation (Biometry)
• Anterior chamber angle examination (gonioscopy)
• Corneal topography
• CFF test
• Hertel Examination
• Other specialized tests (e.g., angiography, anomaloscopy, VEP examination)

What Are the Most Common Supplementary Components of a Comprehensive Eye Examination?

Supplementary tests are always performed alongside the general eye examination; they are not suitable for making a diagnosis on their own. During a comprehensive eye examination, it is important to evaluate the various tests together. It may happen that different diseases show similar abnormalities on one particular test, but when evaluated together, the conditions can be differentiated.

OCT Examination

During an OCT scan, we obtain a high-resolution three-dimensional image of the retina, which is essential for the early diagnosis of diseases, monitoring diseases, and assessing the effectiveness of treatment. During the examination, the patient looks motionlessly at a light point that appears in the device while it maps the central areas of the fundus using light beams.

Following the quick and painless examination, the ophthalmologist reviews all the images, evaluates them, and compares them with the lesions seen on the fundus in order to establish the correct diagnosis. The procedure has opened new dimensions in understanding, mapping, and treating ophthalmological diseases.

OCT is considered a mandatory examination in modern ophthalmological care. Evaluating the images requires specialized professional expertise, in which retina specialists are particularly skilled.

The device itself does not provide any diagnosis. In addition to evaluating and reporting the images, the patient may also receive one or two printed images from the many that were taken. One of the most important supplementary components of a comprehensive eye examination is the OCT scan.

Visual Field Test (Automated Perimetry)

When testing visual acuity, we only assess the vision of the best-seeing central area; we obtain no information about the other, peripheral parts of vision—the visual field. In certain diseases, however, central vision remains intact until the late stages of the disease, while the visual field gradually and irreversibly deteriorates and narrows.

Meaningful information about the functionality of the retina, the optic nerve, and the visual pathways can be obtained through computerized visual field testing, which can sensitively detect abnormalities even in cases of early functional impairment, as well as the extent and severity of visual field defects.

During the visual field test, the patient sits in front of a device with a dome, with one eye covered. The patient must focus continuously on a central point while the device projects various light impulses onto different parts of the dome. The patient must signal by pressing a button when they perceive these light signals, which are automatically recorded and create a detailed map of the visual field. It is important to know that the flashing points are often imperceptible, but in such cases the machine retests them, so there is no need to worry about missing any signals.

Based on the results, the doctor can determine whether there are areas of reduced sensitivity or defects in the visual field, which may be early signs of glaucoma. The examination is painless and takes approximately 10-15 minutes. It requires adequate concentration, so a test performed while tired may limit interpretability. Completing the test is not always easy, but after 1-2 examinations, the exact task can be learned, and the results obtained are generally reliable thereafter.

Visual field testing is essential in the diagnosis and monitoring of glaucoma. In addition, it also provides useful information about the extent of functional loss in other diseases affecting the optic nerve, as well as in various retinal diseases. This examination is frequently performed during a comprehensive eye examination.

Ultrasound Examination

Ophthalmological ultrasound examination is performed with a smaller, specialized ultrasound device. Thanks to this, we can obtain a detailed image of the posterior parts of the eyeball even in cases where optical methods would not be feasible. It is used to assess gross abnormalities of the vitreous and retina.

The ultrasound examination is brief and painless, with no harmful effects on the eye. Vitreous hemorrhage or inflammation, retinal tear or retinal detachment, and mature cataracts are the most common conditions in which we use B-scan ultrasound. Even with clear optical media, it may provide additional information, such as in assessing vitreous adhesion or in cases of eye injuries. This is also a frequently performed examination during a comprehensive eye examination.

Pachymetry

The specialized A-scan type of ophthalmological ultrasound is also used to measure corneal thickness. It is primarily used in corneal diseases and laser vision correction procedures; in glaucoma, pachymetry is performed to refine the accuracy of intraocular pressure readings.

Lens Calculation (Biometry)

During cataract surgery, the clouded lens is removed and an implant, an intraocular lens, is inserted in its place. The eye’s refractive power is provided jointly by the cornea and the lens, so when the latter is removed, we must calculate the power of the intraocular lens to be implanted so that ideally no glasses are needed for distance vision. This complex measurement and calculation process is called lens calculation or biometry.

Previously, only ultrasound-based devices existed, but currently, for premium intraocular lenses, we exclusively use OCT-based devices that operate on optical principles and provide more accurate measurements.

Lens calculation is performed without contact; the patient looks into a device that performs the necessary measurements with a few flashes of light. The obtained data are processed by a computer program, and the doctor then selects the most optimal intraocular lens from these results.

Before the examination, it is always necessary to discuss the exact type of intraocular lens to be implanted with the operating surgeon.

Anterior Chamber Angle Examination (Gonioscopy), Three-Mirror Lens Examination

Certain parts of the eye cannot be examined directly, such as the anterior chamber angle, which is the starting point of the drainage pathway for the eye’s internal fluid. In certain types of glaucoma, there is a drainage obstruction in the anterior chamber angle; this is examined during gonioscopy, which is performed with a specialized contact lens called a three-mirror lens.

Before gonioscopy, anesthetic drops are administered, and after a few minutes the examination contact lens is placed, through which the area is assessed while sitting at the slit lamp. With the same lens, abnormalities in the peripheral parts of the retina can also be examined. The three-mirror lens is also frequently used during laser treatment of glaucoma or retinal tears. This is a frequently performed procedure not only during a comprehensive eye examination but also when glaucoma or retinal tear is suspected.

Corneal Topography

Topography enables detailed examination of the cornea, making early diagnosis of diseases such as keratoconus possible.

During corneal topography, the device scans the cornea with specialized light sources and cameras, then creates a detailed three-dimensional map of the corneal surface using computer software. In addition to diagnosing diseases, it is also frequently used as part of pre-operative suitability assessments for laser vision correction procedures (LASIK, PRK), and is also useful in contact lens fitting.

CFF (Critical Fusion Frequency) Test

The CFF test measures the eye’s and the nervous system’s ability to process visual stimuli. This is done by gradually increasing the frequency of a flickering light from the device until the patient perceives it as continuous.

The point at which the signal’s vibration ceases and we perceive the light as continuously illuminated is called the critical fusion frequency (CFF).

Its normal value is 40-42 Hz, but this decreases with advancing age.

The examination provides important and rapid information about the state of the visual system and the nervous system, for example in cases of optic nerve inflammation or atrophy.

Hertel Examination

Diseases of the orbit often lead to protrusion of the eyeball, the extent of which can be determined with the Hertel exophthalmometer. The quick and painless examination is particularly important in thyroid disease. In endocrine orbitopathy, hyperthyroidism causes inflammation and swelling of the tissues around the eyeball, resulting in protrusion of the eyes (exophthalmos).

Photographic Documentation of the Comprehensive Eye Examination

We also have the ability to photographically document the anterior parts of the eye, the optic disc, and retinal nevi or other abnormalities.

If monitoring the lesion over time is particularly important, comparing the images allows even the smallest differences to be identified, in contrast to written descriptions, which only allow for order-of-magnitude identification.

How Long Does a Comprehensive Eye Examination Take?

A comprehensive eye examination takes at most 2 hours, although most of the individual tests do not last longer than 5-10 minutes each. Of this time, approximately half an hour is waiting time for the pupil-dilating drops to take effect. Thorough documentation of complaints, symptoms, medical history, and examination findings is also time-consuming.

In addition, positioning at the various devices and explaining instructions, explaining the diagnosed diseases, and outlining treatment options also take up a significant portion of this time.

Thanks to our extensive range of equipment, we are able to perform most supplementary tests at our practice, which, unlike other practices, we conduct on the same day in a single session. In certain cases, however, not all tests can be performed on one day, or they may need to be repeated.