Routine Eye Examination

During a routine eye exam, we perform a series of tests designed to assess the complex function of vision and the health status of the eyes. It includes far more tests than the vision screening performed at optical shops, which only involves reading a chart. Its purpose is to preserve good vision and detect any emerging diseases.

We begin the assessment by recording the patient’s complaints and medical history, measuring the eye’s refractive power, and checking visual acuity. This is followed by a slit-lamp examination, during which we direct focused beams of light at the eye under a microscope and examine every tissue of the eye either directly or with various handheld magnifying lenses. Based on the results, we establish a diagnosis, form an opinion on the condition of the eyes, and recommend a treatment plan if necessary.

Why Is a Routine Eye Exam Important?

Regular and thorough ophthalmological examination is important because many eye diseases cause symptoms only in advanced stages and can remain asymptomatic for a long time.

Thanks to timely examination, initially asymptomatic ophthalmological conditions can be diagnosed that, if left untreated, may cause irreversible vision loss or even blindness. Furthermore, ophthalmological manifestations of certain systemic diseases may reveal underlying conditions (e.g., diabetes, thyroid disease, immunological disorders, brain abnormalities, and various tumors).

In cases of existing ophthalmological conditions, we often perform an extended comprehensive ophthalmological examination, unless it is a simple ocular surface infection or similar condition.

When Is a Routine Eye Exam Indicated?

1. Eye Examination When Symptoms Appear

A routine eye examination is necessary whenever we notice any visual complaint or vision deterioration, or when we observe changes on the eye and/or eyelid or periocular area.

Most Common Ophthalmological Symptoms and Signs

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As can be seen from the non-exhaustive list above, a very wide range of ophthalmological symptoms is known; for the fastest and most accurate diagnosis, the ophthalmologist is greatly assisted by the most detailed knowledge of these symptoms.

What to Note When Describing Your Ophthalmological Symptoms

• When the complaints appeared
• Whether it affects one eye or both
• Whether symptomatic at distance, near, or in all cases
• Whether symptomatic with glasses, without them, or in all cases
• In case of discharge: its color, consistency, rate of reproduction
• In case of light phenomena: their shape, location
• In case of spots: whether they move or not, whether central or peripheral
• In case of strabismus: whether constant or not, time of onset
• Color vision change: monocular or binocular, which color

2. Eye Examination During Screening

Even in the absence of complaints and with healthy eyes, periodic eye examination is recommended, as certain diseases can remain asymptomatic for a long time. If possible, request pupil dilation during screening as well, since this allows for a much more thorough examination.

Screening may also include the ophthalmological examination performed as part of occupational health or driver’s license medical fitness assessments. In such cases, in addition to the routine eye exam, other supplementary tests (visual field test, color vision test) must be performed even with healthy eyes. The visual acuity test performed at the general practitioner’s office, while useful, is far from guaranteeing the absence of ophthalmological disease.

The frequency of screening depends on age as well as whether the case is ophthalmologically healthy or at risk.

Recommended Frequency of Ophthalmological Screening
For Healthy Individuals
• Between 0 and 6 years: every 2 years, first at 6 months • Between 6 and 18 years: annually • Between 18 and 64 years: every 2 years • Over 65 years: annually
At-Risk Cases
At least annually or sooner, according to the treating physician’s recommendation

The at-risk group includes the following adults:

• Personal or family medical history of ophthalmological diseases that are hereditary or show genetic predisposition.
• Systemic health conditions with known ophthalmological manifestations.
• Functional vision in only one eye.
  Contact lens wear.
• Eye surgery or previous eye injury.
• High or progressive refractive error.
• Occupations requiring high visual demands or that significantly endanger the eyes.
• Taking prescription or over-the-counter medications with ophthalmological side effects.

3. Eye Examination for Certain Systemic Diseases

Systemic diseases often have ophthalmological manifestations or may affect the eyes as the disease progresses. In such cases, eye examination is indicated at certain intervals even in the absence of ophthalmological symptoms. The table below summarizes the most common disease groups with ophthalmological manifestations, listing a representative condition for each group.

What Is the Process of a Routine Eye Exam?

Recording Complaints, Symptoms, and Medical History

The first step is to record the patient’s complaints and symptoms; the more precise these are, the more helpful they are to the physician in performing targeted examinations. Accurate documentation of medical history is particularly important for patients with multiple conditions who have undergone surgeries.

Determining the Eye’s Refractive Power

The first of the instrumental measurements, usually performed by an assistant or optometrist, is refracto-keratometry, which involves computerized determination of the eye’s refractive power (diopter). The obtained value is not absolutely precise, but in practice this usually has no significance.

Occasionally, however, to reveal uncertain measurements or so-called latent refractive errors, we use temporary paralytic pupil dilation to obtain more accurate values, the effect of which may last one or even several days. The obtained values serve as a starting point for the visual acuity test; if necessary, we also check vision with glasses at this time.

Visual Acuity Test

The visual acuity test is an essential part of the routine eye exam, during which we measure the eye’s ability to distinguish the shapes and details of objects at a given distance. To accurately assess changes in vision, visual acuity testing is measured under standardized conditions.

The theoretical resolving power of the eye is the angle at which rays from an object falling on two adjacent retinal cells are still perceived as separate; in humans this is approximately 0.4 arc minutes. This is the vision beyond which the human eye cannot see more sharply under ideal conditions—essentially the eye’s resolution.

The visual acuity test enables a simple but rapid assessment of the complex process of vision, which deteriorates first and causes symptoms in many diseases. However, there are also conditions where visual acuity remains full for a long time and other characteristics of vision change, which can be assessed with other, more complex tests.

Slit-Lamp Examination

Currently, the standard routine eye exam is performed at a device called a slit lamp, which consists of a movable light source and a binocular microscope, with which most parts of the eye can be thoroughly examined.

During the examination, the patient sits with their head placed in the headrest, initially looking straight ahead, while the physician directs the light beam toward the eye and views it from all directions. To examine the internal parts of the eye (vitreous, retina), the physician must use special supplementary lenses to focus the light on the desired area and may ask the patient to look in different directions.

After the slit-lamp examination, your physician may order additional supplementary tests for a more thorough assessment.

The deeper parts of the eye, such as the lens, vitreous, or retina, are visible only in a small area during the routine eye exam; therefore, we often need to administer pupil-dilating drops, which cause the pupil to dilate, allowing for a much more detailed and accurate examination. With a narrow pupil, even the visible areas make it less possible to distinguish certain abnormalities precisely.

Intraocular Pressure Measurement

Intraocular pressure measurement involves determining the internal pressure of the eye, which measures the pressure of the fluid in the eyeball, the so-called aqueous humor. This test is important for early detection of glaucoma, as in most cases the intraocular pressure, normally between 10–21 mmHg, becomes elevated.

The most accurate method of intraocular pressure measurement is applanation tonometry, which performs the measurement by determining how much force is needed to flatten a small area of the cornea. Before the examination, an anesthetic solution is instilled on the surface of the eye to temporarily reduce corneal sensitivity. During intraocular pressure measurement, the patient sits at the slit lamp, placing their chin and forehead on a support to keep the head stable, and looks straight ahead with eyes wide open and motionless for a few seconds. The device measures intraocular pressure by determining how much force is needed to flatten a small area of the cornea.

For measurement without anesthetic drops, the so-called rebound tonometry is nearly as reliable. During the measurement, a tiny probe from the device briefly touches the surface of the cornea, from which it quickly rebounds, and the intraocular pressure is determined based on this rebound speed.

Measurement with other non-contact devices (non-contact tonometry) is less reliable and is generally used by optical shops for primary screening.

Regular intraocular pressure measurement is particularly important for glaucoma screening, as the disease is often asymptomatic in the early stage and vision loss becomes noticeable only when severe damage has already occurred.

Intraocular pressure measurement is a simple, quick, and painless test that plays a fundamental role in preserving eye health.

What Diseases Can Be Detected During a Routine Eye Exam?

Retinal examination without pupil dilation is a mandatory part of the eye examination. At this time, we can screen for gross abnormalities of the central part of the fundus; however, if disease is suspected, we must perform pupil dilation so that we can examine every part thoroughly.

Fundus examination with pupil dilation is part of the routine ophthalmological examination. For early screening of fundus diseases, we supplement this with OCT examination, which enables cellular-layer-level analysis of tissues. Generally, when we speak of fundus examination, it refers to fundus examination with pupil dilation.

How Should You Prepare for a Routine Eye Exam?

The ophthalmological examination does not require serious preparation, but for the smooth progress of the process and to answer your questions, it is worth reviewing the following points before arriving at the office.

What to Keep in Mind and What to Bring

1. Personal documents: identity card, address card, social security card (the latter is only recommended for subsidized prescription purposes; it is not required for care)
2. List of medications: If you take medication regularly, bring a list of these, which we will request for review if necessary.
3. Family medical history: Inform yourself about ophthalmological problems that have occurred in your family (e.g., glaucoma, cataract, tumors, etc.).
4. In case of acute problems: Note when your symptoms appeared, which eye, how suddenly, how they change, and any circumstances that may be related to your condition.

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Other Useful Tips:

– Recording your questions: If you have several questions, it is worth writing them down briefly so you can easily review and quickly ask them if you did not receive an answer during the briefing.

– Your own glasses and contact lenses: Preferably do not arrive for the eye examination wearing contact lenses, unless your physician requested this or you discussed it with them. It is recommended to remove soft contact lenses at least 3 days before the examination and hard contact lenses at least 2 weeks before. Otherwise, new glasses or contact lenses cannot be prescribed.

Bring your glasses to the routine eye exam and note the current contact lens specifications.

– Issuing certificates, prescribing glasses: Do not forget to indicate at the very beginning of the examination if you need any certificate (e.g., driver’s license, occupational fitness, etc.) or if you would like to have glasses prescribed. In these cases, supplementary tests will be required that can only be performed before pupil dilation. If the opinion on the outpatient form is not sufficient, please bring the form to be completed.

How Long Does a Routine Eye Exam Take?

Generally, a routine eye exam without pupil dilation takes 30–45 minutes and with pupil dilation 60–90 minutes, of which the actual medical examination usually takes five to ten minutes. The remaining time is filled with recording complaints and symptoms, performing and documenting supplementary tests, and explaining the established diagnosis and treatment plan. The pupil-dilating drops require approximately 30 minutes to take effect. If supplementary tests are needed, we can perform them on the same day; these take at most an additional hour and generally last 5–10 minutes each.