What are the different types of eye exams?
Types of eye exams
A routine comprehensive eye exam allows your eye doctor to update your prescription and determine the health status of your eyes. Sometimes, a specialized exam or office visit is needed to manage issues such as binocular vision, low vision or particular eye diseases.
Routine eye exams are important because they catch eye and vision issues early while they are more treatable. If any problems are found, your eye doctor will guide you regarding the best way to manage the condition. They may provide referrals to a specialist or ask you to come back for further testing or a procedure so that they can manage and treat the disease.
Comprehensive eye exam
Getting your eyes examined every year is the best way to ensure that you don’t have any underlying eye health issues. Several eye diseases can cause future eye and vision problems without showing early symptoms. A routine eye exam will also check your vision to check how you are seeing up close and far away.
While every eye doctor’s office is a little different, an eye exam will typically include an assessment of:
Visual acuity – Visual acuity is the ability to see fine detail with clarity. It is measured by your ability to read rows of letters on a chart. These letters will gradually get smaller. Both distance and near visual acuity are tested.
Refractive error – A refraction measures your refractive error. Your doctor will ensure that the prescription in your glasses remains current to help you see clearly.
Eye movements – Your doctor will ask you to follow an object with your eyes only. This examines whether your eyes work together so that you see a single image.
Pupil reaction – The pupils should constrict in bright light. In low light, the pupils should dilate. Checking your pupil’s reaction can provide information regarding damage to the visual pathway of the nerves or the brain.
Depth perception – Your eyes must see clearly and work together for proper 3D vision. Difficulty with depth perception can indicate an underlying vision or eye issue.
Color vision – A change in color vision perception can indicate underlying eye health or vision issues. If someone has had color blindness since birth, it is not a concern.
Peripheral vision – This is the side vision in your visual field. A peripheral vision test can help detect visual field loss. This loss can be due to injuries or diseases such as glaucoma, diabetic retinopathy or stroke.
Eye health – Your eye doctor will look at the outside and inside of your eyes with instruments that have high magnification and bright light. Your pupils may be temporarily dilated to examine the structures inside the eye, such as the lens, optic nerve and retina. The pressure inside your eyes will also be measured.
A comprehensive eye exam can last an hour or more, depending on the health of your eyes and if additional tests are needed.
READ MORE: America's Best eye exam review
Contact lens exam
If you wear contact lenses or want to, your initial appointment will be scheduled for a comprehensive contact lens exam. This means that additional tests will be performed in addition to a comprehensive exam.
These tests include:
Tear film evaluation to ensure you are a good candidate for comfortable contact lens wear.
Measurement of your cornea, the clear front surface of your eyes.
Assessment for the correct fit and type of contact lens for your eyes: the base curve of the lens — a measurement of how flat or steep the lens is — and the lens diameter.
Calculation of the correct contact lens prescription.
Your doctor will provide you with a contact lens prescription. This will include the power of the contact lens, the type of lens and the expiration date.
A follow-up exam to see how you adjust to the new contact lenses will be scheduled.
Pediatric exams
Eye exams for young children and infants or toddlers involve different techniques and tests than for school-aged children or adults.
Children’s eyes are still developing and are vulnerable to certain conditions, such as amblyopia. Young children may be too young to tell you they can’t see well, so it is important to take them to an eye doctor for routine exams.
In very young children, visual acuity is measured by preferential looking. This is when the child looks toward a card with a pattern (stripes) rather than a blank card. Young children generally look at a pattern (if they can see it) rather than a blank card because it is more interesting. This provides an eye doctor with valuable information about the child’s visual development.
When a child can respond verbally, visual acuity is measured similarly to how it is measured for adults — by the ability to read rows of letters on a chart as they gradually get smaller.
An examination for children younger than two years old will assess:
Visual acuity.
Eye health and alignment.
Ability to follow a moving object.
Pupil response to light and dark.
Visual field range, if possible.
Refractive error, if possible.
An examination for preschoolers and school-aged children will assess:
Visual acuity.
Eye health and alignment.
Ability to follow a moving object.
Pupil response to light and dark.
Ability to focus up close.
Depth perception.
Color vision.
Pupil response to light and dark.
Visual field range.
Refractive error.
Ruling out vision issues before an ADHD diagnosis
A child with symptoms typically found in ADHD, such as short attention span, inability to stay on task, and difficulty with schoolwork may need an evaluation by an eye doctor to rule out vision problems. This is because vision problems and ADHD can present with similar symptoms.
Common vision problems include uncorrected refractive error, difficulty focusing up close and eye teaming issues. These issues can cause a child to avoid tasks such as reading and writing. They may lose their place while reading or have difficulty recalling the content of what they read because the visual work of reading requires so much concentration.
If a child has trouble focusing and ADHD is suspected, a comprehensive eye exam followed by a binocular vision assessment may be recommended by an eye doctor.
READ MORE: Could it be ADHD or a vision problem?
Exam for myopia control strategies
Recent studies have found that the nearsightedness (myopia) rate in school-aged kids is skyrocketing. Nearsightedness that progresses into high myopia increases the risk of vision-threatening complications later in life.
Several clinical trials have found that myopia control strategies may reduce the risk of myopia development and progression. After a comprehensive eye exam, your doctor may recommend that your child returns for a follow-up exam to evaluate which myopia control strategy would be most effective. These strategies include:
Daily application of low-dose atropine eye drops
Myopia control eyeglasses and contact lenses
Overnight Orthokeratology
*In addition to these strategies, multiple studies have found that increased time spent outdoors reduces the risk of myopia development and progression. Some eye doctors also recommend frequent vision breaks during extended near work to prevent eye strain and as a possible strategy to slow myopia progression.
Are school vision screenings an eye exam?
Vision issues could still exist if a child had a vision screening at school and no problems were found. Vision screenings are not comprehensive eye exams. Vision screenings do not replace eye exams and can miss refractive errors, eye teaming issues and other eye conditions.
Some children may not reach their academic potential without a comprehensive eye exam to identify, correct and manage undetected vision problems.
Binocular vision exam
As children grow into their school years, binocular vision (the ability of the eyes to work together) is essential. Clear binocular vision is vital for reading, school work, sports, cooking, crafts and every other aspect of life.
A binocular vision assessment may be performed on school-aged children as part of a comprehensive eye exam. Adults experiencing difficulty with depth perception or having other visual issues related to binocular vision may also benefit from a binocular vision exam.
A binocular vision exam will assess:
Vision history, including any visual difficulties.
Vision at distance, near and intermediate ranges.
Eye alignment and teaming.
Ability to follow a moving object.
Ability to focus up close and read for extended periods.
Ability to see clearly when alternating between distance and close vision.
Depth perception.
Hand-eye coordination and spatial awareness.
Vision therapy may be recommended if any issues are found with binocular vision. In addition, some athletes find that they can enhance their “sports vision” with vision therapy focusing on hand-eye coordination and spatial awareness.
Low vision exam
An eye doctor specializing in low vision performs a specialized exam for individuals with visual impairment. A person may be considered to have low vision if their ability to perform activities of daily life such as reading, driving and cooking, even with glasses or contact lens correction, are affected.
Low vision can be due to decreased vision, decreased visual field or both. It leads to a functional loss. A clinical definition of low vision is:
Decreased visual acuity – Visual acuity that is 20/70 or worse in the better eye with best correction.
Visual field loss – The central visual field has been reduced to less than 20 degrees, per World Health Organization (WHO) guidelines.
It is valuable to have a clinical definition of low vision for eligibility for certain services. However, a low vision exam may be recommended for any individual with decreased visual function that impacts their daily life.
A low vision exam includes:
Vision history, including any visual difficulties.
Vision at distance, near and intermediate range.
Retinoscopy.
Autorefraction.
Trial frame refraction: This is a type of refraction in which trial lenses are placed in a trial frame so that functional vision can be more accurately assessed.
Contrast sensitivity testing.
Glare assessment.
Visual field assessment.
Depth perception assessment.
Reading assessment.
Many resources and technologies exist to help people who have low vision. After a complete low vision exam, magnifiers, special electronic devices and other assistive technology, often referred to as low vision aids, will be recommended by the low vision specialist.
A low vision specialist can also provide resources and recommendations for organizations that provide low vision support.
Follow-up visits to manage eye disease and other conditions
Sometimes, an eye doctor will find an issue with the health of the eyes during a routine eye exam. Many different conditions may require more frequent eye examinations or specialized procedures to manage them.
Some common eye conditions that require follow-up exams are diabetic retinopathy, wet age-related macular degeneration and glaucoma. These conditions can cause permanent vision loss if left untreated and may need to be followed more frequently.
A regular eye exam can detect and help prevent irreversible damage to the eye. Routine follow-up visits to manage an eye disease can help prevent severe complications in the future.
Glaucoma
Glaucoma can cause irreversible vision loss without any symptoms at its onset. If a doctor finds you a glaucoma suspect, they may ask to see you more frequently.
At follow-up exams, you will be examined and monitored for signs of glaucoma, including:
Abnormal optic nerve appearance
Retinal nerve fiber layer abnormalities
Visual field defect
Abnormal drainage angle
It is important to follow your doctor’s recommendations for follow-up visits if you are a glaucoma suspect. This condition can permanently damage the optic nerve and cause loss of side vision.
Diabetic eye complications
One of the most common vision-threatening complications of diabetes is diabetic retinopathy. The longer a person has diabetes, the higher their risk of developing retinopathy. It results when uncontrolled blood sugar levels damage the retina’s blood vessels, causing them to swell and leak or block blood flow.
New, abnormal blood vessels can also grow into the retina in diabetic retinopathy. These new blood vessels are leaky and prone to rupture and cause damage to the retina as well. In adults aged 20-74, diabetic retinopathy is the most common cause of new blindness.
If you have diabetes and your doctor finds signs of damage in your eye, they may ask you to return for routine follow-up exams. These exams will require your pupils to be temporarily dilated to examine the inside of the eye. This is to monitor you for diabetic retinopathy and additional complications such as:
If you have diabetes, your eye doctor and primary care provider may work together to help prevent diabetic complications in the eye.
Age-related macular degeneration (AMD)
AMD is an eye disease that affects the center of your vision, impairing your ability to see the details of what you are looking at.
AMD is the most common cause of vision loss in adults over 50. It is caused by the gradual degeneration of the macula, resulting in decreased visual acuity. There are two types of AMD, dry and wet.
Dry AMD can occur when the macula becomes thinner with age. Small clusters of proteins, called drusen, accumulate around the macula. It is a slowly progressing condition. About 80% of people with macular degeneration have the dry form of AMD.
Wet AMD is the type of AMD for which your doctor may ask you to return for follow-up exams. This type of AMD is called “wet” because blood and fluid can leak from abnormal blood vessels that have begun to grow under the retina. Scarring and tissue damage occur more rapidly, resulting in faster vision loss than with the dry form of AMD.
If you have AMD, your doctor will give you an Amsler grid to help monitor your vision at home. They will want to examine your retina more routinely if you have wet AMD so that any blood leakage in the retina can be promptly treated.
Is the vision test at the DMV an eye exam?
The vision test at the DMV is not an eye exam. The DMV does use an eye chart to test vision. But a DMV vision test only assesses whether you have the required visual acuity to drive safely according to each state’s laws. Almost anyone can perform it.
A comprehensive eye exam is a complete examination of your eye health and vision and can only be performed by an eye doctor.
The importance of eye exams
Routine comprehensive eye exams will help to provide a lifetime of clear vision and healthy eyes. Eye exams not only keep your prescription up to date, but they also maintain eye health by detecting issues early.
Your eyes and vision continue to change from childhood through old age. Safeguard your eye health and eyesight by following your eye doctor’s recommendations on how often you should be seen for an eye exam.
School-aged vision: 6 to 18 years of age. American Optometric Association. Accessed October 2022.
Eye screening for children. American Academy of Ophthalmology. March 2021.
How to conquer the pediatric eye exam. American Academy of Ophthalmology. June 2018.
Basic pediatric eye exam. University of Iowa Health Care Ophthalmology and Visual Sciences. September 2020.
IMI prevention of myopia and its progression. Investigative Ophthalmology & Visual Science. April 2021.
Time spent outdoors in childhood is associated with reduced risk of myopia as an adult. Scientific Reports. March 2021.
High myopia and its risks. Community Eye Health Journal. May 2019.
Low vision. National Eye Institute. April 2022.
What is low vision? American Academy of Ophthalmology. September 2021.
Glaucoma suspects: A practical approach. Taiwan Journal of Ophthalmology. June 2018.
Diabetic retinopathy. National Eye Institute. July 2022.
Age-related macular degeneration (AMD). National Eye Institute. June 2021.
What is macular degeneration? American Academy of Ophthalmology. February 2022.
Page published on Monday, October 31, 2022
Page updated on Monday, October 31, 2022
