Your Sight
Getting Professional Eye Care

At a complete eye exam, called a dilated eye exam, the eye doctor widens the pupil of the eye with eye drops to allow a closer look at the inside of the eye. This exam may not be part of an eye exam for a new pair of eyeglasses or contact lenses. Be sure to ask your eye doctor for a dilated eye exam.

How Often Should I Have an Eye Exam?

Prevent Blindness recommends that everyone receive a comprehensive eye exam through dilated pupils regularly as recommended by your eye doctor.

At a complete eye exam, called a dilated eye exam, the eye doctor widens the pupil of the eye with eye drops to allow a closer look at the inside of the eye. This exam may not be part of an eye exam for a new pair of eyeglasses or contact lenses. Be sure to ask your eye doctor for a dilated eye exam.

Prevent Blindness recommends that everyone receive a comprehensive eye exam through dilated pupils regularly as recommended by your eye doctor.

In general, the recommended frequency of comprehensive eye examinations for people without symptoms or special risk factors is:

20-39 Years Old

If you are 20-39 years of age and African-American, you should get a complete eye exam every 2-4 years.

40-64 Years Old

If you are 40-64 years of age and African-American, you should get a complete eye exam every 2-4 years.

65 Years Old or Older

You should get a complete eye exam every 1-2 years.

People with Special Risks

People with special risks, such as diabetes, a previous eye trauma, surgery or a family history of glaucoma, may need an eye exam more frequently.

Who’s Who in Eye Care?

There are several types of specialists for you to contact for help with questions and problems regarding your eyesight. The following definitions were provided by each corresponding professional organization.

Ophthalmologists

(Definition provided by the American Academy of Ophthalmology. For more information, contact the AAO)

An ophthalmologist is a physician (doctor of medicine or doctor of osteopathy) who specializes in the comprehensive care of the eyes and visual system in the prevention of eye disease and injury. The ophthalmologist has completed four or more years of college premedical education, four or more years of medical school, one year of internship, and three or more years of specialized medical and surgical training and experience in eye care. The ophthalmologist is a physician who is qualified by lengthy medical education, training and experience to diagnose, treat and manage all eye and visual system problems, and is licensed by a state regulatory board to practice medicine and surgery. The ophthalmologist is the medically trained specialist who can deliver total eye care: primary, secondary and tertiary care services (i.e., vision services, contact lenses, eye examinations, medical eye care and surgical eye care), and diagnose general diseases of the body.

Optometrists

(Definition provided by the American Optometric Association. For more information, contact the AOA)

The optometrist is a health care professional trained and state licensed to provide primary eye care services. These services include comprehensive eye health and vision examinations; diagnosis and treatment of eye diseases and vision disorders; the detection of general health problems; the prescribing of glasses, contact lenses, low vision rehabilitation, vision therapy and medications; the performing of certain surgical procedures; and the counseling of patients regarding their surgical alternatives and vision needs as related to their occupations, avocations and lifestyle. The optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete a residency.

Opticians

(Definition provided by the Opticians Association of America. For more information, contact the OAA)

Opticians are professionals in the field of designing, finishing, fitting and dispensing of eyeglasses and contact lenses, based on an eye doctor’s prescription. The optician may also dispense colored and specialty lenses for particular needs as well as low-vision aids and artificial eyes.

Certified Ophthalmic Registered Nurses

(Definition provided by the American Society of Ophthalmic Registered Nurses. For more information, contact ASORN at 415/561-8513.)

A certified ophthalmic registered nurse is a registered nurse who has a specialized body of knowledge, skills and experience. Ophthalmic nurses perform ophthalmic examinations, patient assessments based on human responses to ophthalmic diseases, triage, teach patients about their ophthalmic conditions and prevention, assist in eye surgeries and provide emotional support to patients and their families. Ophthalmic registered nurses work in operating rooms, ambulatory clinics, private offices and hospitals. The goal of ophthalmic nursing is to assist patients in preserving and maximizing the vision that they have, prevent disabling eye disease through education, promote independence, and enhance the patient’s quality of life. Eligibility for certification (CRNO) requires two years of practice in ophthalmology before taking the written examination.

Certified Orthoptists

(Definition provided by the American Association of Certified Orthoptists.)

The orthoptist, an allied health professional in ophthalmology, works in an adjunctive capacity with an ophthalmologist in the diagnostic and therapeutic assessment of children and adults with strabismus, amblyopia, diplopia and disturbances of binocular function. Expert in the visual assessment of nonverbal patients and in the performance of diagnostic tests used to evaluate visual function, the orthoptist may also be skilled in refraction, visual field testing, electrophysiologic testing, contact lens evaluation and low vision assessment.

Certified Ophthalmic Personnel

(Definition provided by Joint Commission on Allied Health Personnel in Ophthalmology.)

These individuals, such as ophthalmic assistants, ophthalmic technicians and ophthalmic medical technologists, are qualified to assist the ophthalmologist in a variety of procedures, from history taking and basic tonometry to visual field testing and ophthalmic photography, depending on the level of certification. Certification in the subspecialty areas of Ophthalmic Surgical Assisting and Assisting in Low Vision are also available. The Joint Commission on Allied Health Personnel in Ophthalmology is the certifying agency.

Paraoptometric

(Definition provided by the American Optometric Association.)

A person who works under the direct supervision of a licensed doctor of optometry, collects patient data, administers routine yet technical tests of the patient’s visual capabilities and assists in office management. The paraoptometric may assist the optometrist in providing primary patient care examination and treatment services, including contact lenses, low vision, vision therapy and optical dispensing and office management. State laws may limit, restrict or otherwise affect the duties that may be performed by the paraoptometric.

Optometric Assistant

(Definition provided by the American Optometric Association.)

A paraoptometric who is primarily involved in front office procedures, optical dispensing and contact lens patient education. The optometric assistant may be trained on the job or may have completed a formal education program that is less than one academic year in length, and successful completed the National Optometric Assistant Registry Examination. A registered optometric assistant will be designed by Opt. A., R.

Optometric Technician

(Definition provided by the American Optometric Association.)

Getting Ready for My Eye Doctor Appointment

Have you ever left the doctor’s office and thought of a dozen questions you meant to ask? We all do that! This checklist of questions can help you make the most of your next visit to the eye doctor.

When you call to make an appointment:

  • Be prepared to describe any vision problems you are having.
  • Ask if you will be able to drive yourself home. Will the eye examination affect your vision temporarily?
  • Ask how much the exam will cost. Do any of your health insurance plans cover any of the cost? How is payment handled?

Before you go in for your examination

Make a list of the following:

  • Signs or symptoms of eye problems you have noticed (flashes of light, difficulty seeing at night, temporary double vision, loss of vision, etc.)
  • Eye injuries or eye surgery you have had (approximate dates, hospitals where treated, etc.)
  • Prescription and over-the-counter drugs you are taking.
  • Questions you have about your vision.
  • Your general health condition (allergies, chronic health problems, operations, etc.)
  • Family history of eye problems (glaucoma, cataracts, etc.)

Take along the following:

  • Your glasses, contact lenses or both.
  • Prescription and over-the-counter drugs you are taking.
  • Medical or health insurance card or your membership certificate.

During the examination

  • Ask questions about anything that seems unclear to you, such as the names and purposes of tests you may undergo.
  • Ask if there are any changes since your last exam.
  • Ask when it is best to call the doctor with questions.
  • Find out when you should return for your next exam.

Getting Refractive Surgery

Anyone considering refractive surgery should become well-informed about the various surgical alternatives.

Refractive surgery encompasses a variety of technologies and procedures for correcting several common eye conditions such as myopia (nearsightedness) and hyperopia (farsightedness).

Introduction

The surgery changes the focusing characteristics of the eye to achieve a clearer image. These surgeries may change the shape of the cornea, implant an artificial lens, or alter the eye in other ways.

Refractive surgery offers millions of eyeglass and contact lens wearers new alternatives for improving their vision. While most of these people are accustomed to the benefits of eyeglasses or contact lenses, few understand the technology, benefits and risks associated with refractive surgery. Because of the large impact refractive surgery is likely to have on the visual well-being of so many Americans as well as on standards of eye care, Prevent Blindness America has set forth this statement which, in summary, suggests:

Anyone considering refractive surgery should become well-informed about the various alternatives.

They should also carefully review the procedure’s potential benefits and possible risks, including a thorough discussion of these and other facets of their surgery with their own doctor. Prevent Blindness America takes no position regarding the appropriateness or recommendation of refractive surgery for any given patient or under any given circumstances.Eye care professionals who provide refractive surgery should do so only within the prevailing standards of care and in the best interests of the patient. The instruments used in refractive surgery should be used only in accordance with applicable laws and regulations.

Issues regarding the inclusion or exclusion of the various forms of refractive surgery within the legal scope of practice of any given eye care profession are best decided by appropriate state licensing entities. Prevent Blindness America takes no position regarding scope of practice matters.

Types of Refractive Surgeries

Three forms of refractive surgery are now commonly available in the U.S.:

Radial Keratotomy, or RK as it is often called, is one of the oldest forms of refractive surgery. In RK, an eye surgeon usually uses a scalpel to make from four to eight tiny cuts into the cornea. The cuts are arranged like spokes on a wheel. The cuts allow the cornea to flatten, lessening its focusing effect on the light entering the eye. This process is most commonly used to correct nearsightedness.

Photorefractive Keratectomy, PRK, is a more recent development in refractive surgery. Like RK, PRK changes the shape of the cornea to correct problems like nearsightedness. In PRK, however, a laser is used to remove the outer layers of the cornea to create a flatter shape. The laser instrument used in PRK can also re-shape the cornea to correct conditions like nearsightedness and astigmatism.

LASIK is an acronym for Laser In Situ Keratomileusis. LASIK is another type of refractive surgery that uses a laser to reshape the cornea. Rather than removing the outer layers of the cornea like PRK, a surgeon performing LASIK first uses a special cutting instrument to cut a thin flap into the top of the cornea. This outer flap is folded back and the exposed inner tissue of the cornea is then reshaped with the laser. Afterward, the flap is folded back into place. This preserves the outer layers of the cornea and helps to speed healing.

Several other forms of refractive surgery are under development but are not yet widely available. The safety and effectiveness of these procedures are under study. These include the following:

Intrastromal corneal ring segments are curved plastic strips that are surgically implanted into the cornea. The segments push outward on the cornea to flatten its shape to correct nearsightedness. Segments of different thicknesses can be used to create the right amount of change in the cornea. Segments can also be exchanged if the implanted ones do not produce the desired effect.

Intracorneal lenses are tiny lenses that can be surgically placed directly into the cornea. Like a contact lens, these can be shaped to correct most refractive error. Implantable contact lenses function like the soft contact lenses many people place on the surface of their eye. These lenses, however, are implanted by a surgeon not on the cornea, but inside the eye in front of the natural lens using surgical techniques similar to those used to correct cataracts.

Undoubtedly, additional refractive procedures will be developed and these surgeries may soon offer even more choices for correcting common vision conditions.

Safety

By the time refractive surgeries are widely available to the public, they are generally performed thousands of times and are carefully studied to demonstrate their safety and effectiveness. In addition, instruments used by surgeons for many of these procedures are regulated by the U.S. Food and Drug Administration and have been approved for these uses.

Like any other surgery, however, refractive surgery also has potential risks. These risks fall into three broad categories: over correction or under-correction of the vision problem being treated, complications after the surgery such as infections or scarring, and damage to the eye caused by problems that occur during the surgery.

The most common problem with refractive surgery is over- or under-correction. This simply means that the change created in the focusing power of the eye is too great or too small. Ideally, refractive surgery returns a person’s vision to normal without the need for additional correction with eyeglasses. However, the amount of change created by the surgery can only be estimated by the surgeon. While the accuracy of these predictions is usually high, it is possible that a person will still need additional correction to see at 20/20 or some other acceptable level. RK in particular has been shown to cause a gradual shift toward over-correction a number of years after the surgery. Any long-term changes from other refractive surgeries will only become known after the surgeries have been available for ten or more years.

Complications that can occur after refractive surgery include infections and corneal scarring. Although uncommon, infections can cause problems ranging from discomfort and delayed healing to serious damage to the cornea and permanent loss of vision. Corneal scarring is also uncommon but can occur as a result of infection, the presence of diseases like rheumatoid arthritis, or other problems with the eye’s natural healing process. Mild corneal scarring can result in poorer-than-expected visual acuity. Severe cases can reduce vision significantly and permanently, even to the point of blindness.

Damage to the eye resulting from problems that arise during surgery is rare, but can have serious results. In RK, for example, it is possible for the surgeon to cut too deeply and penetrate completely through the cornea, rupturing the eye. The instrument used to cut the flap in LASIK can cut too deeply or not deeply enough. Other problems can occur unrelated to the skill of the surgeon or the quality of the instruments used, such as unusual reactions to anesthesia.

It is impossible to discuss every possible complication of every refractive surgical procedure in this brief document. Your doctor should review with you the possible complications of the procedure you are considering and answer your questions about these.

Refractive Surgery Considerations

Prevent Blindness takes no position regarding the appropriateness or recommendation of refractive surgery for any given patient or under any given circumstances.

Refractive surgery can offer a permanent alternative to glasses or contact lenses to many people with common vision problems. People with nearsightedness or astigmatism can benefit from the currently available forms of refractive surgery. Those with farsightedness may have to wait for new or refined refractive surgeries to arrive.

If you are counting on refractive surgery to free you from wearing glasses or contact lenses, you should be aware that there is no guarantee the surgery will accomplish this. As mentioned above, a small percentage of patients will continue to need their eyeglasses or contact lenses due to over- or under-correction. There is no way that an eye doctor can guarantee that you will no longer need glasses or contact lenses to reach the clearness of vision you desire after the surgery.

Cost is another factor to consider before seeking refractive surgery. The surgery can cost several thousand dollars per eye and is usually not covered by most medical insurance plans. If you are uncertain about your insurance coverage for refractive surgery, contact your insurance company.

In addition, as people get older, they find it increasingly difficult to change focus from seeing objects far away to seeing up close (for example, when reading). This condition is called presbyopia. In general, refractive surgery does not relieve this problem. Most people who have refractive surgery will need reading glasses as they get older. However, some people who have refractive surgery chose to have one eye corrected for seeing objects far away and the other eye corrected for seeing objects close up. If you are concerned about the future need for reading glasses, you should discuss this alternative with your doctor.

Also, as mentioned above, refractive surgery can have serious, if uncommon, risks. For example, blunt trauma to an eye that has had radial keratotomy can cause rupture and loss of the eye. It is very important that you understand and carefully consider these risks before consenting to surgery. Your doctor should describe these risks for you and you should make certain that all your questions regarding them have been answered before making your decision.

Finally, some people are simply not good candidates for refractive surgery because of the risks presented by their health status or other characteristics. For example, people with connective tissue diseases such as rheumatoid arthritis or lupus erythematosus may be more likely to suffer severe scarring as a result of refractive surgery.

People with certain eye conditions like glaucoma, retinal disease or dry eye also may not be good candidates for refractive surgery.

People taking certain medications including immunosuppresants or corticosteroids are at greater risk of infection following surgery. Be sure to inform your doctor of any health problems you may have and any medications you may be taking.

Refractive Surgery Providers

In the United States, refractive surgery procedures can be performed only by a physician licensed to practice medicine and surgery, generally a medical doctor (M.D.) or a doctor of osteopathy (D.O.). Most frequently, this is an M.D. specializing in ophthalmology. Oklahoma and Kentucky are currently the only states that permits optometrists (O.D.) to perform some types of  “laser surgery.”

Individual state licensing agencies and legislatures determine which procedures the various eye care providers can perform. Prevent Blindness America believes issues regarding the legal scope of practice of any given eye care professions are best settled by appropriate state licensing authorities and/or legislatures and takes no position on scope of practice issues.

Both optometrists and ophthalmologists may be involved in the care of a refractive surgery patient before and after the surgery. Doctors who provide refractive surgery must also conduct the surgery within the prevailing standards of care and in the best interests of the patient. Since some of the instruments and lasers used in refractive surgery are regulated by the U.S. Food and Drug Administration, doctors should use these instruments only in accordance with applicable laws and regulations.

Health Insurance and Your Eyes

Most people require some kind of eye care throughout their lifetime, but how do they pay for it? Insurance can be a confusing topic in any circumstance but this is especially true when it comes to our eye health. The following fact sheets answer common questions about health insurance, the Affordable Care Act and eye care.

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Medicare Benefits and Your Eyes

Medicare beneficiaries, especially those at risk for or diagnosed with a variety of diseases, are entitled to a number of vision-related services. It is especially important for people with diabetes, a family history of glaucoma, or those who have suffered an eye disease or injury to be aware of and utilize these benefits.

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Vision Care Financial Assistance

Contact information for organizations and services that provide financial assistance for vision care.

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