Outline of an Eye Test
1.“ First we must ask you to sign for your examination” We currently charge £40.00 for our private examination, which includes retinal photography. |
2.“If you would like to take a seat, Mrs. Bowers will be with you shortly” Mrs. Bowers takes a personal interest in all of her patients. |
3.“If you would like to follow me”. |
4.You are asked to step into the consulting room and to make yourself comfortable in the leather-bound testing chair. |
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“How long is it since your last examination?”
“Why have you come, is this a routine visit or is there some problem?”
“Please tell me all the medication you take (tablets, inhalants,
injections, creams, etc.). The repeat prescription form you take to the
pharmacist is very useful.”
“I need the name of your doctor in case I need to notify him for any reason”
Health
“ Is your general health good or do you suffer from asthma, eczema, hayfever or allergies?”
Ocular History
“Have you ever had conjunctivitis, black eyes, hurt your eyes or injured them?”
“Have you ever had any eye operations or treatment?”
Family History
“ Is there any family history of cataracts, blindness, glaucoma, diabetes, lazy eyes?” “Did your parents, grandparents, aunts, uncles, brothers or sisters have anything wrong with their eyes?”
What is your occupation?
“ Do you use a computer and if so, how many hours a day?”
Sports and Hobbies
“I need to make a list of the sports and hobbies that you do, so that I know what you look at”
“Just look at the little white light.” When I cover first one eye and then the other I am checking that your eyes are straight. If one of the six extra-ocular muscles in each eye is weak then you may see the light move form side to side, diagonally or up and down as your eye moves.
“Just look at this picture on my stick.” I am checking that your eyes converge (move in). This is the movement that your eyes make to read.
“Watch my pen torch and follow it with your eyes” This test is called motility, it shows me how well your eye muscles work to look at or track a moving object. If the pen torch goes blurred or double then one of your extra ocular muscles may be weak.
Now I am looking at the external part of your eyes to check that they are healthy. I need to see how your pupils react to light.
This
instrument is called an Ophthalmoscope, it’s a bit like a torch with
focussing lenses to let me look inside your eye, to check that it is
healthy. I might ask you to move your eyes so that I can see the
periphery (outer edge). They call your eye the window to your body and
I can certainly know a lot about your general health, just by looking
in your eyes.
Now I am measuring the distance between your eyes with a ruler so that I can set up the trial frame so that it fits you and you look through the centre of the lens.
I must ask you to read the letter chart, with each eye separately so that I can record your unaided vision (how much you can see without spectacles).
Now I am using an instrument called a Retinoscope. I can shine a beam of light into your eye and the light rays come back out. Then I can look at how the beam of light is moving (reflex) and measure your prescription (the power your spectacles need to be).
I need to measure your vision with the retinoscopy prescription in trial frame. So I will ask you to read the letters with each eye separately to check the result of the previous test.
Having covered one eye, so that we test one eye first (and then the second one), with the result of the retinoscopy test lenses in the trial frame, I will ask you:
“ Can you see the little gaps, where the rings are broken, clearer on the red panel or clearer on the green panel?” The wavelength of the red light is longer, so its focuses further back on your retina. The green light has a shorter wavelength so that it focuses further forward. I need to focus your eyes slightly on the green, so that your accommodation (focusing mechanism) is active (working), ready for the next test.
This works even if you are colour-blind as the wavelengths of the two colours are still different.
Most people have a little bit of something called astigmatism. Astigmatism is when the front surface of your eye is not round like a football but slightly oval, rugby ball shaped. Most people have 0.75Dcyl of astigmatism (ovalness). I need you to look at the black spots on the two white rings. The crossed cylinder introduces two different cylinders in two different directions, ninety degrees apart. I will ask ”Is it clearer with lens number one or lens number two” and move the crossed cylinder so you can experience both powers. They may look both the same, in which case neither make it clearer. This measures your amount of astigmatism.
Next we go back to the red and green duocrome rings and now I focus you slightly on the red, so that your accommodation is more relaxed.
Then we repeat all of this on the other eye Then we need to balance your eyes to work together, so we blur one eye slightly and focus the other eye slightly on the red duocrome rings. Then we repeat it for the other eye.
Your six extra ocular muscles may have a weakness in one of them. One of your eyes can see one of the red nominus bars and the other eye sees the other red bar, either side of where the X is on the word OXO. We use a Polaroid filter so that you can only see one of the red nominus bars with each eye. I simply line up the two bars until they are level using lenses called prisms. Prisms bend the light rays so that we can line your eyes up, to work together. You should then have binocular vision (both eyes together).
I ask you if the spots are bigger and blacker on the red or on the green. This tells me how much focussing power you have left in the Ciliary muscles inside your eyes. This is called accommodation. When you age your eyes loose accommodation and you may need help with reading, either stronger spectacles for reading, or reading glasses. I will ask you to read the small print
You may have an extra ocular muscle weakness at near, so this box repeats the test with the Nominus bars at near to see if you have a weak eye muscle when you read. At the end of your examination I may decide to carry out one or more supplementary tests.
Near point of convergence
When you want to read or look at a computer your eyes must move inwards
this is called convergence. I ask you to look at a little black spot in
the middle of a black line and move it closer to check how well your
eyes can turn in. If you convergence is weak then you may need to do
special eye exercises to strenghthen the muscles.
At the end of every eye examination we will give you a copy of your prescription.