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Home » Your Eye Health » Eye Exams » Your Comprehensive Eye Exam

Your Comprehensive Eye Exam

Your eyes are one of the most complex organs in your body. A comprehensive eye exam to assess your visual system and eye health involves a number of different of tests. Unlike a simple vision screening, which only assesses your vision, a comprehensive eye exam includes a battery of tests in order to do a complete evaluation of the health of your eyes and your vision.

The tests that you will undergo in a comprehensive eye examination may vary from eye doctor to eye doctor but here are are some common exams that you may encounter:

Patient Background and History

One of the most important parts in a comprehensive eye exam is your patient health history. This information will alert your doctor to any conditions that should be monitored closely, such as an allergy to any medications, current or family history of systemic or eye pathology or environmental conditions that could be affecting your vision or eye health. This will also help your doctor to determine any preventative eye care measures that are relevant to keep your eyes healthy for years to come.

Visual Acuity

Visual acuity is a measurement of your vision using an eye chart, the Snellen Eye Chart. In this test the patient is seated at a standard distance and is asked to read letters or symbols of various sizes, which get smaller as you move down the chart. The results are the familiar ratio of 20/20, 20/40 etc. which is a comparison of your vision compared to the average person with good vision, which is typically 20/20. For example, a patient that has 20/40 vision, can only see at 20 feet what the normal person can see from a distance of 40 feet. This test is a preliminary test of how clearly you are seeing in each eye but it does not give you a prescription for corrective lenses.

Refraction

Those who don’t have 20/20 vision have what is referred to in most cases as a “Refractive Error.” The patient may have nearsightedness, farsightedness, astigmatism or other eye conditions that prevent the patient from seeing 20/20. A refraction will tell the doctor which prescription lenses will correct your eyesight to achieve 20/20 vision or whichever amount your vision is correctable to.

A refraction may include a couple of steps.

Retinoscopy

Retinoscopy is a test that allows the doctor to obtain an approximate prescription for eyeglasses. In this test the doctor uses a hand-held instrument called a retinoscope that shines a light into the patient’s eye. The doctor then analyzes the reflex of the light from the patient’s eye to determine the patient’s prescription for glasses.

An instrument called a phoropter is something most patients associate with an eye exam. This space age appearing instrument, positioned in front of the patient’s face during the eye exam, gives the doctor the ability to determine the patient’s focusing ability as well as their eye alignment. The phoropter also determines which, out of the hundreds and hundreds of potential eyeglass prescriptions, will help the patient see as clear as possible. Using the phoropter, the doctor will ask the patient which series of lenses makes their vision the clearest.

While retinoscopy is quite effective for children and nonverbal patients, there are now a number of computerized or automated instruments available today to help doctors accurately determine a patient’s eyeglass prescription.

Autorefractors and Aberrometers

Autorefractors and aberrometers are computerized machines that are able to measure your refractive error to determine your prescription for glasses or contact lenses. These instruments are usually used in addition to testing described earlier:

– An autorefractor is similar to retinoscopy, which electronically analyses the light reflex from the patient’s eye.

– An aberrometer measures distortions or aberrations in the cornea and lens of the eye that disrupt proper focus of light on the retina. Using wavefront technology, the instrument measures the rays of light as they pass through your eye to look for imperfections which may indicate a refractive error.

Eye Focusing and Eye Teaming Tests

During the comprehensive eye exam, your eye doctor will also want to test how your eyes function individually and together from a mechanical perspective. In order to see clearly and comfortably, your eyes need to work together as a team.

Eye Health

The final and most important aspect of a comprehensive eye exam is a check of your overall eye health. These tests (below) are done to identify any eye conditions or diseases, both inside the eye as well as the external parts of the eye, that could affect your vision and general health.

Slit Lamp Test

The slit lamp or biomicroscope is an instrument that allows the doctor to examine the internal and external parts of the eye in detail, such as the conjunctiva, iris, lens, cornea, retina and the optic nerve. The patient rests their forehead and chin on a headrest to stabilize the head, while the doctor looks into the eye with the slit lamp microscope, which is magnified with a high-intensity light. A slit lamp test enables the doctor to evaluate the eyes for signs of normal aging and eye pathology, such as conjunctivitis, cataracts, macular degeneration or retinal detachment. Early diagnosis and treatment of eye diseases are essential for preventing vision loss.

Tonometry

Tonometry is a test to detect glaucoma by measuring the pressure inside your eye or IOP (intraocular pressure). Glaucoma can cause vision loss and even blindness if the IOP in the eye is too high and damages the optic nerve.

The applanation tonometer, typically attached to a slit lamp, is one of the most common instruments used to measure the pressure in the eye. Prior to doing this test the doctor will numb the patient’s eyes using an anesthetic, before gently applanating (putting pressure on) the patient’s cornea to measure the pressure in the eye.

Pupil Dilation

During your comprehensive eye exam, your doctor may decide to do a dilated eye exam. In this test, your doctor will instill dilating drops in each eye, which would enlarge your pupils to give the doctor a better view of certain parts of the back of the eye. Dilation is done at the discretion of the doctor, with some patients dilated every year and others at specified intervals; the frequency of dilation will vary for each patient.

Typically the drops take around 20 to 30 minutes to take effect and may last up to several hours following the exam; each patient is different. Since more light enters your eyes when your pupils are dilated, you will be more sensitive to bright light, especially sunlight. Although your doctor may provide disposable sunglasses, you may want to bring a pair of sunglasses to wear after the exam to make it more comfortable until the drops wear off.

A comprehensive eye exam is an important part of your overall general health maintenance and should be scheduled on a regular basis. The findings from your comprehensive eye exam can give your doctor important information about your overall health, particularly diabetes and high blood pressure.

Dear Patients,

We will be reopening our office Monday, May 18, 2020, and would like to bring you up to date with the many very important physical and procedural changes we have made to our office to assure the highest level of health and safety for our patients and staff during these very challenging times.

We have consulted with our county, state and federal officials, as well as the CDC and other healthcare professionals, to incorporate the recommended and required safety measures throughout our office.

We sincerely apologize for any inconvenience we may have caused by rescheduling or postponing your earlier appointments.

To assure the health and safety of our staff and patients, as well as minimize any exposure, we have instituted the following changes. Please read through this entire document and print a copy so you are familiar with them.

1. Any and ALL appointments and visits will need to be scheduled. This includes the pickup of eyeglasses or trial contact lenses, frame selection, eyeglass repairs, and eyeglass adjustments.

2. Contact lenses will be shipped to all patients at no charge

3. To maintain social distancing and minimize any possible exposure, we have spread out our patient schedule.

4. 24-48 hours before your appointment, one of our staff will be calling to remind you of your appointment and discuss your ocular and medical history. In addition, they will ask you standard COVID19 screening questions and answer any questions regarding your upcoming exam. This will take 5 – 10 minutes but this initial call is important to allow you ample time in our office.

Please look for and answer this call.

5. In order to save time and keep everyone on schedule, any and all medications you are taking should be listed in as much detail as possible on a separate piece of paper, emailed to our secure site: DROXENBERG@COMCAST.NET, or entered on the patient registration form on our website: WWW.DROXENBERG.COM. This needs to be completed prior to your appointment and should include all systemic medications (diabetes, hypertension, etc.) and ocular medications (eye drops, glaucoma medicine, etc.).

6. On the day of your appointment please plan to arrive 15 minutes early and call us at (717) 394-3798 when you arrive. We will return your call when you will be allowed to enter. Entry will be through the front door only unless previously discussed with our staff. Only the person with the appointment will be allowed in the office with the exception of minor children who have the appointment. NOTE: Family members and/or friends will need to wait outside.

7. We will be taking your temperature in the vestibule and anyone with a temperature of 100 degrees or higher or who is sick will be rescheduled. If you feel ill, please reschedule your appointment.

8. All staff will have their temperatures checked 2 times daily for your safety.

9. All staff will wear a facemask while in the office. In addition, all patients must wear a facemask while in the office as mandated by Governor Wolf for all PA businesses. If you do not wear a facemask, one will be provided to you.

10. There are hand sanitizing stations strategically placed throughout the office. Please use them.

11. All frames will be disinfected before and after being handled by patients and staff. Frames will not be returned to the frame display until they are appropriately disinfected.

12. All exam room equipment will be cleaned and disinfected before and after each use according to the CDC guidelines.

13. Cleaning and disinfection of our office have always been a priority and this will continue in earnest.

14. Preferred payment is by credit card or checks at the time of services but cash will be accepted.

15. We have installed a plexiglass barrier on our front desk to comply with the CDC and state guidance.

16. Reception area chairs have been separated to maintain social distancing.

17. Patients who are physically disabled will be allowed entry through the rear door, with prior approval, following a temperature check and COVID19 screening. All other patients must enter through the front door and screening vestibule.

18. Above all else, your safety and health are our top priorities. We take this responsibility very seriously and have implemented these changes in procedures to achieve this.

Dr. Oxenberg has been providing eye care to you and your family since 1990 and expects to continue for many years to come.

If you have any questions and /or concerns, please feel free to email our office at droxenberg@comcast.net or call (717) 394-3798.

We look forward to seeing you all again!

Sincerely,

Dr. Larry Oxenberg