Tips to Prepare for an Eye Exam

Updated on May 15, 2017
Daughter Of Maat profile image

With over two decades of experience in medicine, Melissa Flagg writes patient information articles, keeping you informed about your health.

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After conducting eye exams on thousands of eyes over the past 20 years, I’ve learned that patients can get pretty nervous when you start doing things to their eyes. In fact, I’ve been hit with just about everything—including a shoe—by patients attempting to keep me from putting drops in their eyes!

In an effort to save patients from having to throw their personal belongings (and to help keep other technicians from getting hit with those objects), this article will divulge all of our best-kept secrets. These tips will not only make it easier for you and the staff; they will also help you get the most thorough eye exam possible.

The single most important thing you can do to get the best eye exam is to:

Be Up Front About Everything

In the interest of efficiency, you need to tell your tech exactly why you are there. For example, if you want your reading prescription checked, tell the tech in the beginning, especially before drops are instilled. Unless you’ve had cataract surgery, or are over the age of 70, reading prescriptions can’t be checked once you’re dilated. It’s also a good idea to tell your tech at the beginning of your appointment so when they go to check your distance prescription, your reading vision can be checked at the same time.

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What to Expect During Your Routine Eye Exam

Most ophthalmologists have assistants called ophthalmic technicians (that’s me). These assistants, or “techs,” perform the initial parts of the eye exam including:

  • Getting the history, this includes the patient’s complaint as well as personal and family medical history
  • Reading the prescription in any glasses the patient may have
  • Checking the patient’s vision
  • Refracting the patient (testing the patient for a new prescription)
  • Testing the patient’s eye pressure
  • Dilating the eyes in preparation for the doctor’s exam

The reason the doctors have staff to do this part of the exam, is twofold actually. First, they need to see more patients. Insurance doesn’t pay what it should, and to compensate, doctors need to be able to see a higher volume of patients than would otherwise be required. Second, it is faster and more efficient for the patient…most of the time.

Getting through an eye exam is actually pretty easy if you have a technician who has years of experience. These techs know what they are doing, and they know how to make a patient feel at ease. When a technician in training conducts your exam it can get awkward fast. Follow these tips, however, and it won’t matter if your technician has been on the job for fifteen minutes or fifteen years.

The Initial Part of the Exam

The first part of any exam is to find out why the patient (you) is in the office in the first place. To those of us in the medical profession, this part of the exam is officially called the “history.”

The problem with the history is that the technician needs to get a lot of detailed information out of the patient in about five minutes or less. Unfortunately, this isn’t enough time as many patients don’t know exactly why they are there, but they know they have a problem.

The history needs to cover several different aspects including:

All prescription medications can affect the eyes. Make sure to bring all your medications or a list of them to your eye doctor appointment.
All prescription medications can affect the eyes. Make sure to bring all your medications or a list of them to your eye doctor appointment. | Source
  • History of present illness, or HPI (also known as the “chief complaint,” or CC), or why you are actually there that day
  • If you have had any previous eye surgeries, or a history of eye diseases
  • Current medical history such as whether or not you are diabetic
  • Your family health history (has anyone in your immediate family ever had high blood pressure, diabetes, cancer, etc.)
  • Any allergies to medications, foods and anything else (it's important to let the tech know if you have any food allergies such as shrimp or other seafood; these foods contain iodine, which can indicate you may have an allergy to other dyes used in diagnostic testing such as fluorescein).
  • Any medications you are currently taking – if you take any medications, either bring the bottles with you, or make a list with names, strengths (50mg? 100mg?), and how often you take them because systemic medications affect the eyes!
  • Occupation and type of work

The Chief Complaint or History of Present Illness

This is the one part of the exam every new technicians hate mainly because it’s very easy to get confused, forget to ask a question, or upset a patient. But this interaction is so important that it can make or break the exam. If a tech is not successful in gaining the trust of the patient, the whole exam will be inaccurate.

To prepare for this part of the exam, it is essential that you know what is wrong if you have a problem. Let’s say, you’re having trouble reading road signs. Before you go to your eye appointment, you need to know the answers to the following questions:

  • Is your vision blurry, fuzzy, foggy, or dim? (There is a big difference among these adjectives!)
  • How long have you been having trouble? (6 months? 1 year? 1 week?)
  • Did the symptoms occur suddenly, or gradually?
  • Does it affect one or both eyes? If both eyes are affected, is one eye worse than the other?
  • How often does it occur? Is it constant or intermittent?
  • Are there any other associated symptoms? Do you have glare from oncoming car lights? Do you have difficulty reading up close?
  • How severe is the problem? Do you have to be right up on the sign to be able to read it?
  • Does anything make it better? Does squinting, or blinking help? Do your current glasses (if you have any) make it better or worse?

I know it seems like you’re playing 20 questions, but if you know all the answers to these questions (or better yet, have written the answers down), your exam will take half the time, and be much more thorough.

Tell Your Technician Everything!

I can’t stress enough how important it is to tell your tech everything. If you don’t, and you end up telling the doctor something you didn’t tell the tech, you may have to repeat the exam. Not to mention, the tech will be reprimanded for not being thorough, even if it wasn’t their fault.

For example, let’s say you’re taking Plaquenil for rheumatoid arthritis. You neglect to tell the technician because you don’t think your medications affect the eyes. Once you get to the doctor, he looks at your eyes and immediately knows you have rheumatoid arthritis because of damage to the retina and asks if you are taking medications.

Now, because you didn’t tell the tech, you will have to come back when you aren’t dilated to have a color vision screening and visual field test. Plaquenil can cause a red/green deficiency in the vision, a problem called Plaquenil toxicity.

There are a number of medications that can affect the retina and the visual system as a whole. It's very important for you to tell your technician about all your medications including Coumadin, Plavix, aspirin, fish oil, ibuprofen and vitamin E, all of which thin out the blood.

Checking Your Vision

After getting your history down, the tech will move on to checking your vision. If you have glasses, your vision will be checked with them. I always get asked “why do you need to check my vision with the glasses?” If you have glasses, and wear them when you are driving, obviously you can’t see perfectly without corrective lenses. We check with the glasses to see if the prescription needs to be changed. This brings me to my next point:

Remember to Bring Your Glasses!

Bring your glasses to your eye exam, even if they are completely broken.
Bring your glasses to your eye exam, even if they are completely broken. | Source

Even if they are ancient, or broken, or a lens is missing, bring your eyeglasses. Having even a partial prescription is extremely beneficial to your tech, and the doctor.

If a lens is missing, that's okay. It is very rare for both eyes to have completely different prescriptions (although it can happen), so even one lens is helpful. Other reasons to bring your glasses are:

  • If your prescription changes drastically, we won’t know if you don’t bring them. Cataracts have a nasty habit of sneaking up on patients affecting their vision without them knowing.
  • Comparing the old prescription to the new one can signal that more testing needs to be done, which could lead to a vision saving find that would have otherwise been missed.

The Phoropter

The Phoropter is used during the test known as the refraction, can be really tricky, especially for new technicians
The Phoropter is used during the test known as the refraction, can be really tricky, especially for new technicians | Source
This is what you (and the tech) look like during a refraction.
This is what you (and the tech) look like during a refraction. | Source

The Refraction

This is another area of the exam that many patients (and techs) dread. I don’t know how many times I’ve heard “I’m really bad at this. I can never tell a difference between the two lenses.” That’s okay. My best piece of advice is this:

If You Can’t Decide Between One and Two, Say So!

Let me explain: After the vision check, your technician will most likely read the prescription in your glasses (some techs do this first), and then refract, or check, to see if your glasses need to be changed.

This involves putting the patient (you) into a machine called a phoropter (see photo). Usually the phoropter is preset with your current prescription, or the tech will perform a test called retinoscopy in which they use a light to determine what your prescription should be.

Retinoscopy is the most objective way to get a patient’s prescription, and, in my opinion, the only way. If the tech is good enough, he or she can easily pin down your prescription with retinoscopy alleviating the need for a lengthy and tiresome refraction.

Without going into the theory of refraction, refining a glasses prescription is really an art form and involves asking the patient which lens option is better.

If you can’t tell a difference between one and two it is because your vision can’t be improved any further, so let the technician know. The differences between the two lenses are meant to be difficult to determine, but sometimes there is absolutely no change when the lenses are switched.

It is also important to go with your “gut instinct” when choosing between one and two. If you think about it, and have the tech repeat one and two several times, your eye will have time to focus and accommodate the prescription, which can make the final outcome inaccurate.

At the same time, the technician shouldn’t rush you. If you feel rushed, let someone know. You may have to come back to repeat the refraction, but that’s better than spending $400 on a pair of glasses with an incorrect prescription.

How to Tell if You Are Nearsighted or Farsighted

Some people may not know the difference between hyperopia (farsightedness) and myopia (nearsightedness), let alone know into which category they fall. If you are one of these people, here’s a quick, 2 step trick to figure it out. You’ll need a magazine or newspaper and your glasses.

  1. Hold your glasses over the words on the page of the newspaper or magazine, and pinpoint one word or sentence on which to focus.
  2. Move the glasses back and forth over the selected word or sentence and notice what happens to the letters.

Did the letters get bigger or smaller? If they got bigger, you’re hyperopic. If they got smaller, you’re myopic.

If any of the lenses make the letters look smaller and blacker, tell the tech. Smaller and blacker means there is too much power, which can cause headaches and eye strain. Myopes (nearsighted people) have more of a problem with this than hyperopes (farsighted individuals) because of the nature of their prescription.

If you are nearsighted, make sure you’re paying attention. It may look clearer at first glance, but in reality it's smaller and blacker, which is not clearer. Unfortunately, this is one of the subtle nuances of refraction with which new technicians always have a hard time. Knowing this ahead of time, can help you get the best prescription possible.

Also, try to stay as still as you can behind the phoropter (see photo). The tech will align your eyes in the phoropter prior to refracting you. If you move around after the tech has done this, your prescription won’t be right.

Quick Tip: Blink!

Another quick tip: blink! Try not to stare at the chart during your refraction. You need to keep blinking your eyes so that they don't become dry, which actually changes your prescription. The tear film keeps the cornea clear. It's like a window, when the window is dirty (or the cornea becomes dry) your vision will become blurred, hazy and foggy. When you blink, you clean the window and your vision returns to normal.

When you do blink, be sure to blink normally. Don't squeeze your eyes shut as this can blur the vision by putting pressure on the cornea.

There is much more involved in an eye exam than just getting a pair of glasses. In fact, your overall health can be determined just by looking at the eye. Many diseases, like diabetes and brain tumors, are first diagnosed by the ophthalmologist. With these tips, you can make their job much easier (and your exam a bit less tortuous) minimizing the likelihood that a diagnosis may be missed.

Questions & Answers

    © 2012 Melissa Flagg OSC

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      • profile image

        jpergl 

        16 months ago

        Great information. I've had dozens of eye exams and never had anyone tell me what I should or shouldn't be doing during an exam.

        Thanks again.

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        3 years ago from Rural Central Florida

        Yes, voltaren can have an effect on the eyes, in fact for years it was used in drop form as the first line of defense to treat inflammation. However, it has since been replaced with newer less caustic anti-inflammatory drugs. When used systemically, in pill form, Voltaren can have a greater effect on the eyes; however, the gel form of the drug which I used topically in the skin is less likely to cause a problem since only about 6% of the drug makes it to the blood stream. Hope that answered your question! :)

      • aesta1 profile image

        Mary Norton 

        3 years ago from Ontario, Canada

        I wish I had read this hub before my eye examination. I would have been more careful in making sure my prescription was okay. I saw Voltaren in one of the pictures you used. Does Voltaren affect the eyes?

      • brakel2 profile image

        Audrey Selig 

        4 years ago from Oklahoma City, Oklahoma

        Hi - I just had my eye exam and wish I had read this thorough article beforehand. You covered everything very well. The only difference was the eye doctor put drops in my eyes after part of the exam. My husband was impressed, as his eyes are uneven and that was done well. I haven't seen you in the forums, so I went on a hunt to find you. I actually found you on Pinterest. Your knowledge of medicine is excellent. Hope you enjoy your writing and good to see you again doing well. Audrey

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        5 years ago from Rural Central Florida

        @StandingJaguar Indeed, most people performing the refraction don't even ask their patients if the letters are smaller and blacker. For myopes with a strong prescription (over -6.00 diopter) the duochrome test should always be used to ensure the patient doesn't have too much minus power. Refraction is truly an art form, and very difficult to master.

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        5 years ago from Rural Central Florida

        @Eiddwen Thank you!!

      • StandingJaguar profile image

        Amy 

        5 years ago from Colorado

        Nice to know about the "smaller and blacker" tip for nearsighted folks. I once had to change a prescription (it turned out to be too strong, just like you said) because of headaches.

      • Eiddwen profile image

        Eiddwen 

        5 years ago from Wales

        Great tips which will benefit many.

        Eddy.

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        5 years ago from Rural Central Florida

        @Barbara Thank you!!!

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        5 years ago from Rural Central Florida

        @phoenix :D anything for you!

      • Barbara Kay profile image

        Barbara Badder 

        5 years ago from USA

        This was excellent.

      • phoenix2327 profile image

        Zulma Burgos-Dudgeon 

        5 years ago from United Kingdom

        Thanks DOM. I seem to remember being given a prescription a while back. I guess I better go and dig it out.

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        5 years ago from Rural Central Florida

        @phoenix Why thank you! I don't know how I do it, actually, If I did I'd make a lot more money!

        You should carry your contact lens rx with you whenever you go to the doctor. Usually they'll give you a copy of it, because most RGP wearers don't have a back up pair of contacts because of the cost. Also make sure you let the tech know what solution you use, although I suspect it's Boston. :D

      • phoenix2327 profile image

        Zulma Burgos-Dudgeon 

        5 years ago from United Kingdom

        Another great hub. How do you do it?

        I wear gas permeable contact lens 99.9% of the time. Is there anything else I should do to prepare for an eye exam?

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        5 years ago from Rural Central Florida

        @Novel Treasure Thank you! Many of my patients found my advice helpful during my career. I thoroughly enjoyed giving my patients the inside info, and it made them feel much more at ease. Hopefully my hubs will do the same! :D

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        5 years ago from Rural Central Florida

        @jaydawg808 Thank you!! :D

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        5 years ago from Rural Central Florida

        @billybuc Yep, I poked and prodded in eyeballs for 16 years, and now I get to write about my experiences lol. I've worn glasses all my life as well. I think that's what sparked my interest in ophthalmology. I was always fascinated whenever we went to the eye doctor during my childhood. My mom was grossed out, but I was really into it.

        There is quite a bit of technology now, some of which is new to me as well, but I keep up to date on everything with my ophthalmic journals, LOVE my journals.

      • Daughter Of Maat profile imageAUTHOR

        Melissa Flagg OSC 

        5 years ago from Rural Central Florida

        @lovedoctor926 Thank you! Get to the eye doctor!!! :D

      • Novel Treasure profile image

        Novel Treasure 

        5 years ago from US

        A very well written, informative hub. It's really great to get the perspective from the doctor's point of view. Voted up and useful.

      • jaydawg808 profile image

        jaydawg808 

        5 years ago

        Very well done, thank you!

      • billybuc profile image

        Bill Holland 

        5 years ago from Olympia, WA

        I didn't know this is what you did for a living! I have worn glasses since I was five years old. I hadn't had my glasses check in the last ten years, and just went in for an exam and I couldn't believe the new technology...it was a brand new experience for me, and that's saying quite a bit.

        Anyway, very interesting hub my friend.

      • profile image

        lovedoctor926 

        5 years ago

        useful share. this reminds me. I need to make an appointment for an eye exam. It's been a while.

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