AN EYE EXAMINATION: WHO, WHAT, WHY AND HOW?

Read on to find out who, what and why – but what you really need to know is HOW!

Pick up the phone and call Sarah Gibson Optometrist on 01963 34333 or click here to email us. Send us your telephone contact details and we will call you back to arrange a convenient appointment. We are not yet able to offer online booking but watch this space...

WHO?

Everyone should have their eyes examined regularly. How often depends on a number of factors and your eye care practitioner will tell you when you should be seen again. You should not leave it more than two years between eye examinations, even if you think your vision is fine.

Your eye examination will be performed by a qualified Optometrist. We used to be called Ophthalmic Opticians. Dispensing Opticians are highly qualified people but are not qualified to perform a full eye examination. Some Dispensing Opticians are also contact lens fitters. Many practices use Optician in their names. (The situation is much like the high street chemist’s – the qualified professional is the pharmacist but s/he works in a Chemist’s shop).

WHAT (is an eye exam)?

An eye examination is not just a check to see if you need spectacles or contact lenses. A full eye examination checks the health of your eyes as well as your vision. We also check that the muscles controlling your eyes are working properly and can advise you on ways of reducing eyestrain at home and at work.

Some eye conditions can lead to blindness if they are not detected and treated early enough. Some conditions, such as glaucoma, cause damage long before you develop any symptoms.

WHY?

Eye examinations can save lives! Did you know that an optometrist could be the first person to detect high blood pressure, diabetes or high cholesterol? Luckily we don’t see nasty things very often but occasionally an eye examination reveals a potentially life threatening condition.

HOW?

There are many parts to an eye examination, all of which are important.

History & Symptoms – We will ask you several questions so that we know why you have come to see us and what we might expect from your eyes and vision. For example we may ask:

  • Why have you come for an eye examination?
  • What specs or contact lenses do you currently wear?
  • Can you see everything that you want to see or do you have some problems with your vision?
  • Have you ever had any accidents or injuries to your eyes?
  • Is there anyone on your family with eye problems?
  • Does anyone in your family have any significant health problems?
  • How is your health?
  • Are you taking any medication?
  • Do you work?
  • Do you drive?
  • Do you have any hobbies or play any sport?

Vision & Prescription check – This is where we check what you can (or can’t!) see with and without your existing spectacles or contact lenses and see if we can improve your vision in any way. There are various methods to check your prescription so no two eye examinations will ever be exactly the same. We may also check your colour vision and will perform various tests to see how well your eyes work together as a pair.

If you have any hobbies that require good vision, or use a computer either at home or at work, we may ask you specific questions about the distance at which you need to see things clearly. If you use a computer at work you may be entitled to a specific VDU examination paid for by your employer.

Examining the health of the eye. This is the bit that a lot of people find disconcerting but it is one of the most important clinical aspects of the examination and cannot be missed out. It is where we shine the bright light at your eyes and come very close. We have a machine called a fundus camera to examine the central retina in more detail but we still use the ophthalmoscope to get a wider view (more details about this fantastic technology can be found by clicking here.)

Additional tests- There are several additional tests that we can perform if we need more information about the health of your eyes. You may not have all of these tests at every examination. Some of these are only routinely performed on clients over a certain age and some are performed if people complain of certain symptoms. We are always happy to explain what we are doing so please don’t be afraid to ask.

  • Field test – this checks your peripheral vision which can be affected by a number of conditions including glaucoma. It is the one with the flashing dots.
  • Pressure test – we don’t use the dreaded “puff test” that most high street opticians use. Instead we use a small hand held device that does not puff at you or require any drops. Our regular clients will be familiar with our previous Perkins pressure test which involved anaesthetic drops. This new device is called an iCare tonometer and, so far, all our clients have told us that this one is even better than the Perkins test. The pressure test is used to measure the pressure inside your eyes to monitor for potential glaucoma. We may still occasionally need to use the Perkins test to confirm readings if the iCare readings are much higher than expected.
  • Slit lamp examination – this is like a large microscope that we usually use to examine the outside of your eye in greater detail. It is used at all contact lens aftercare appointments.

Discussion of your eye-care needs – This is the final part of your examination. We will go over the results of the tests that we have performed and advise you if you need to change your current spectacles or contact lenses, if you need to start wearing them for certain tasks, or if we need to refer you to your GP for some reason. Once we have gone over the results we will give you a copy of your prescription and, if necessary, introduce you to another member of the team who will help you choose some new spectacles or book you in for a contact lens fitting.

Contact lens aftercare appointments are different to a normal eye examination. If you wear contact lenses you should always:

  • Tell the receptionist that you wear contact lenses so that you are offered an appropriate appointment
  • Wear your contact lenses to every appointment
  • Have your lenses in for at least 4 hours before your appointment, preferably longer.
  • Bring your contact lens case & solution (where appropriate) and your glasses with you as you will be asked to remove your lenses.

COMPUTERS AND YOUR EYES

Computer users tend to complain of eye strain more than non-users. As well as the more obvious signs of discomfort, headache or blurred vision this fatigue adversely affects concentration and productivity.

There is no reliable evidence to suggest that long term computer use is damaging to the eyes but display screens are significantly more visually demanding than simply reading paper documents or books.

In legislation computer screens are usually known as VDUs (Visual Display Units) or DSE (Display screen equipment.)

If you are employed and use a VDU at work for a significant part of your working day your employer is obliged to provide you with an eye examination and to provide a suitable pair of spectacles if they are required specifically for VDU use. This is part of the Health & Safety (Display Screen Equipment) Regulations which came into force on January 1st 1993.

A DSE / VDU examination is not the same as a normal eye examination. A full eye examination of a VDU user will incorporate an in depth discussion of the workstation and general office environment in addition to the usual health and lifestyle questions asked during a standard eye examination. This information is used to determine the likelihood of VDU specific eye-strain and to recommend corrective measures. Recommendations on simple changes to workstation or lighting are just as likely to be a part of the solution as corrective spectacles or contact lenses.

Fatigue & eyestrain with VDU use is likely to be caused by such factors as :

  • An uncorrected eyesight fault such as long sight, short sight, astigmatism or presbyopia, even if this fault causes no symptoms outside of the office.
  • The eyes not working together as a pair
  • Insufficient and infrequent rest periods
  • Incorrect positioning of screen and / or documents
  • Poorly designed work area
  • Unsuitable lighting

In order to perform an appropriate examination and to provide relevant advice following a VDU examination the optometrist will need the following information:

  • Any symptoms associated with VDU work (e.g. itchy or dry eyes, headaches, tiredness)
  • How long is spent at a VDU in any one session
  • How long is spent at a VDU in a day
  • Position of screen (e.g. above or below eye level, off to one side)
  • Distance from eye to screen and from eye to any documents
  • Angle and distance between documents and screen
  • Size of the screen, its resolution and refresh rates (if known)

If you are going for a VDU examination, ask your employer if they have a questionnaire that you can complete before you go the optometrist. It is not sufficient for your employer to provide average times and measurements, they need to be as accurate as possible and relate to you and your workstation. If your employer does not provide you with a questionnaire you should contact your optometrist and ask if they have one available that you can complete prior to your appointment.

OPTICAL COHERENCE TOPOGRAPHY (OCT)

An OCT scan has been likened to an MRI scan for your eyes. It enables us to see beneath the surface of the retina and build up a detailed 3D image of the layers of the retina.

The Topcon Maestro OCT scan shows so much detail that it can pick up the very earliest signs of glaucoma, making it possible to pick up signs of glaucoma before it affects your sight, and indeed before it is detectable using the more traditional techniques used by most opticians.

Research has shown that OCT scans detect glaucomatous changes to the retinal nerve fibres some 3-4 years before the peripheral vision is affected. We believe that OCT is the definitive screening tool currently available for this condition.

The macula is the part of the retina which is responsible for our sharp, central ‘straight ahead’ vision. This is the vision we use for seeing detail rather than movement, for example when reading, sewing, using a computer or mobile phone, or recognizing faces. Any change to the macula can cause permanent reduction in your vision and the earlier we can detect change the sooner appropriate treatment can be initiated.

Macula degeneration can be seen using fundus photography but it is often difficult to determine the type of degeneration as most of the critical changes are happening beneath the surface. With an OCT macula scan we can easily tell the difference between the two types of macula degeneration, Wet and Dry, and can make much more accurate referrals if treatment is required.

As we get older the vitreous, the jelly that helps to keep the shape of your eyeball, changes. It becomes less firm and shrinks away from the back of the eye. In most cases it detaches cleanly from the retina but sometimes parts do not detach and cause 'pulling' of the retinal surface. The danger of a Vitreous Detachment is that there is no pain and your eyesight will seem unchanged but the back of your eye may be being damaged. Vitreomacular traction can clearly be seen and monitored with OCT.


Macular Cross Scan

Full Macular Scan

A Macula hole is a small hole in the macula. There are many causes of Macula holes but the most common one is via the advance of a Vitreous Detachment. As the vitreous pulls away from the back of the eye sometimes it fails to 'let go' and eventually tears the retina, leaving a hole. Extreme exposure to sunlight (i.e. staring at an eclipse) can also cause a hole to develop.

As eye-care professionals we have chosen to invest in the OCT as we believe it offers our patients the latest in comprehensive eye-care.

We recommend OCT for all our adult patients as part of an ongoing ocular health assessment, but especially for those people who are most at risk of eye conditions such as glaucoma and macular degeneration.

If you have a family history of glaucoma or macula degeneration and are over 40 years of age we would particularly recommend OCT scanning. We also recommend it for anyone over the age of 50 as the likelihood of conditions such as macula degeneration, glaucoma and vitreous detachment all increase with age.

As one would expect, an OCT scan goes above and beyond what is covered by the NHS for a standard sight test. As a result there is an additional charge for having this procedure done but, as this is less than the cost of a haircut or manicure, and much less than the cost of an MOT for your car, we believe it is extremely good value. Please ask a member of staff for more information on OCT scans.

OCT scans are included as standard for all our Eyeplan members who receive unlimited enhanced eye examinations as part of their membership.