The Ultimate Guide to Eye Exams

Eye exams are one of those things that many of us tend to put off unless something’s wrong or we’re in need of a new prescription for glasses or contacts. Yet, they’re actually a really important part of your routine preventative care and they can uncover a variety of issues and even give your eye doctor an indication of your overall health. Today we’ll be going over everything you need to know from what happens at the appointment to the average eye exam cost.


Why do I Need an Eye Exam?

Think of a comprehensive eye exam as a physical for your eyeballs. These exams, performed by an optometrist, or sometimes an ophthalmologist, check your vision prescription and test your visual acuity. However, they also look at your eye and visual system as a whole. Your eye care professional screens for common eye diseases and conditions, which, if caught early, can often be treated or managed, evaluates how your eyes work together and even assesses your eyes and vision as a clue to your overall health.

While people of all ages should have an annual eye exam, children’s eye exams are exceptionally important. It’s estimated that when it comes to a child’s learning, 80% is based on vision. If their vision is impaired or certain visual skills don’t develop properly, they may need to use different strategies and techniques to ensure they can learn, play and grow like their peers. Knowing that an issue is present early on, allows you to address it or adapt your child’s surroundings to meet their needs. Since children, particularly younger ones, can’t always communicate or may not understand that something is wrong with their sight, children’s eye exams are key to ensuring their vision and eye health are on track.

What’s the Difference Between an Optometrist and an Ophthalmologist?

So, what’s the difference between an optometrist and an ophthalmologist? And, what about an optician? People sometimes use these terms interchangeably but they’re actually three different eye care professionals that have varying specialties and degrees of training. Depending on your needs, one or all three may be a part of your eye care team.

A doctor of optometry, or an optometrist, is a primary care provider for the eyes. After receiving their bachelor’s degree, they must obtain a four-year Doctor of Optometry degree. Optometrists typically perform your routine comprehensive eye exams. They’re expert in:

  • Examining and diagnosing disorders and diseases of the eye and visual system like refractive errors, cataracts, glaucoma and macular degeneration
  • Recognizing related conditions like high blood pressure, brain tumors and diabetes
  • Fitting and dispensing eyewear and contact lenses
  • Removing foreign bodies from the eye
  • Co-managing pre- and post-operative care for laser eye surgery
  • Co-managing ocular diseases in tandem with your ophthalmologist

If you are found to have a systemic eye disease or you need eye surgery, your optometrist will refer you to a specialist known as an ophthalmologist.

Ophthalmologists specialize in eye disease and surgery. They too receive a bachelor’s degree but then go on to four years of medical school, followed by a residency in medical and surgical care of the eyes at a university hospital. A visit to an ophthalmologist usually requires a referral from your optometrist.

The last eye care professional is an optician. They attend a college program to fit and fabricate vision aids, like glasses, according to the prescription of an optometrist or physician. While opticians are licensed to dispense eyeglasses and contact lenses, they don’t evaluate, diagnose or treat conditions of the eye and they don’t write contact lens and glasses prescriptions.

What is the Optometrist Looking for During an Eye Exam?

These are some of the problems and conditions your optometrist will check for at your eye exam:

  • Refractive Errors – Hyperopia (farsightedness), myopia (nearsightedness), presbyopia (age-related, normal loss of near focusing ability) and astigmatism all affect how clearly you can see and typically require some sort of vision correction like contacts, eyeglasses or reading glasses. During your eye exam, the optometrist will determine if you have a refractive error and, if you do, what your eyeglass or contact lens prescription is.
  • Amblyopia – A lazy eye, or amblyopia, is sometimes apparent when a baby is around six months old. One eye has weak vision or vision loss. It can often be treated with vision therapy, a patch, eyeglasses or contact lens. If caught and addressed before the age of eight, it will usually go away completely. However, it becomes harder to treat as a child gets older and can lead to blindness in one eye. This is why it’s so important for kids to have regular comprehensive eye exams starting at six months of age.
  • Strabismus – Commonly called crossed eyes (though eyes can also turn up, out or down), strabismus is a childhood eye condition that, if left untreated, may lead to a lazy eye. Like amblyopia, it can be evident as early six months of age and it is something the optometrist looks for during children’s eye exams. It’s usually treated with glasses, prisms or vision therapy and, occasionally, surgery.
  • Cataracts – Cataracts are characterized by cloudy or distorted vision when the lens of the eye loses its transparency. It feels almost as if you’re looking through a fogged-up window and it can make it hard to drive, read or even see facial expressions. Sometimes, early on, a change in your glasses prescription and stronger lighting can help with cataracts. Once they progress and if they begin to interfere with your daily life, surgery may be recommended.
  • Macular Degeneration – This is a leading cause of vision loss in older adults and it results in degenerative changes to your central vision (straight-ahead vision). The macula collects images from the center of the field of vision and sends them to the brain via the optic nerve. With macular degeneration, the macula cells deteriorate and the brain doesn’t receive the images correctly. At first, sufferers don’t usually notice any vision change but as it progresses, it leads to blurry or wavy vision and, eventually, a complete loss of central vision. There are a variety of treatment options, such as medication, laser treatments, vitamins and surgical procedures that can manage the symptoms and hopefully prevent severe vision loss.
  • GlaucomaGlaucoma is actually a group of eye diseases that damage the optic nerve and can cause vision loss and blindness. Most people have no pain or early symptoms, which presents a problem because early detection is vital for managing it and warding off vision loss. Your optometrist will screen for glaucoma and if they detect it, immediate treatment is recommended to delay the progression. Treatment may include medication, laser trabeculoplasty and surgery.
  • Other Related Diseases – By examining your eyes, an optometrist can sometimes tell that you’re developing issues like high blood pressure. Diabetes is another condition that’s closely tied to the eyes, as diabetic retinopathy, which leads to swelling or weakening of the blood vessels in the retina and the growth of new blood vessels, can cause blindness if untreated. Your optometrist can play an important role in detecting and co-managing some health issues along with your other medical practitioners.

What Happens During an Eye Exam?

Though it will vary depending on your age and needs, a comprehensive eye exam might include:

  • A chat about your medical history and vision needs – Your optometrist will likely ask about any vision and medical issues, both past and present, as well as your family history. They may also discuss your visual needs with you, such as whether you work or go to school, use devices frequently and what type of recreational activities you do.
  • A visual acuity test – The eye test chart your doctor asks you to read off of measures how sharp your vision is. They’ll test the visual acuity of both eyes individually, together, with and without corrective lenses and from near and far distances.
  • Retinoscopy and refraction assessment – When you’re looking at the eye test chart through the phoropter (the contraption you look into with the all of the lenses and dials), the doctor will also use subjective and objective tests (think, “Which is clearer? A or B?” and cover tests), as well as shine light into your eyes, to assess your refractive status and focusing power. This lets them fine-tune your eyeglass prescription or, perhaps, let you know you don’t need vision correction. 
  • Binocular vision test – The optometrist will test how well you see with both eyes together to check eye coordination, depth perception, eye movements and, occasionally, hand-eye coordination
  • Colour vision evaluation – Sometimes, an optometrist will administer a test to determine if you have colour vision deficiencies.
  • Slit lamp – The slit lamp, which is the tool that shines that high-intensity narrow beam of light into your eye, lets the optometrist see the entire front of your eye in three-dimensions, including your lens, cornea, conjunctiva, iris and eyelids. They may also use a biomicroscope, ophthalmoscope and dilation, when needed, to assess the eye inside and out.
  • Neurological assessment – They’ll test your visual system, including testing pupil reactions, assessing peripheral vision and checking ocular motility. You might be asked to follow a light without moving your head or to raise your hand when you see a flash of light in your peripheral vision.
  • Glaucoma screening – That puff of air in an eye exam that, yes, most of us dislike, is very important. Called non-contact tonometry, it measures the pressure inside of your eye to determine your risk of glaucoma. As an alternative, the optometrist can also apply a numbing eye drop and test the eye pressure by touching the eye with special instruments. The puff of air doesn’t sound so bad now, does it?

Now, what about a vision screening or a contact lens exam? Both of these are different from a comprehensive eye exam. A vision screening, which is offered in schools, at pediatricians’ offices and at free clinics, is just checking to see if vision correction is necessary. While it can be valuable and let parents know their child probably needs glasses or contact lenses, it is not a comprehensive screening that evaluates eye health or tests for different conditions. The contact lens exam is also a separate thing and not part of a routine eye exam, though it’s often performed at the same time if you request it. During a contact lens exam, the optometrist will fit you for contact lenses and determine your correct prescription.

How Often Should You Have an Eye Exam?

Kids should have their first eye exam at six-months-old, then again prior to starting kindergarten. After that, it’s recommended that children’s eye exams be scheduled every year. Once you reach the age of 18, if you’ve had good eye health, you will need a comprehensive exam every one to two years. Your optometrist will let you know if you should visit more frequently. For those aged 61 and older, it’s important to have an annual eye exam, as the risk of certain conditions like macular degeneration and cataracts increases significantly as you age. 

What Does the Typical Eye Exam Cost?

The average eye exam cost in Canada will depend on the province you live in and your insurance coverage. For example, in BC, routine eye exams are an MSP benefit for people under the age of 19, as well as those 64-years-old and over. If you fall between the ages of 19 and 64, they’re only covered under certain circumstances. Because contact lens exams aren’t part of the routine eye exam, you may be charged a contact lens fitting fee. Follow-up visits may also not be covered. However, there are tons of places that offer comprehensive eye exams for a reasonable price and it’s certainly worth the investment.

Now that you know why eye exams are important and what to expect at your next one, schedule a visit with your eye doctor to keep your vision crisp and healthy. Then, swing by the Spectacle Shoppe to check out our selection of stylish eyewear in Vancouver!

Morgan Nahanee
Morgan Nahanee


Morgan is The Spectacle Shoppe’s Lead Technician and Customer Relations Specialist as well as a Principle of Spectacle Shoppe. She is a licensed contact lens fitter and dispensing optician and has been working for The Spectacle Shoppe since 2006. She graduated from Douglas College’s two year Dispensing Optician and Contact Lens Fitting Program in 2008. From contact lens fitting to eyeglass repairs and adjustments Morgan is eager to help you with any optical needs. Connect with Morgan Nahanee on Google+