Eye Exams Toronto
Eye exams have come a long way over the decades, and are very different from the ones your parents and grandparents might have had, though the core components are similar. In a city like Toronto, eye exams that are offered from office to office, optical to optical can vary a lot, from the very quick and basic to a more thorough exam much like going to your family physician for a yearly physical.
At 360 Eyecare we provide comprehensive eye exams to all ages. Our optometrists toronto see patients as early as 6 months of age and diagnose and treat vision and eye conditions of all stages. Our optometrists leverage the most innovative technology in the industry to help perform a thorough and precise examination.
Our goal is to help everyone in the Toronto area to see to their maximum potential with optimum optical lenses and visual aids because we know how important your ocular health is. We strive to provide the full circle of care to all our patients.
So what are some of the tests and devices you’ll come across in the modern eye exam?
The Basics of a Comprehensive Eye Exam
An eye exam covers more than a single prescription check. An optometrist will systematically go through several visual assessments and health screenings over the course of the appointment. What you might consider a simple question or a basic action could tell the optometrist quite a lot about the physical condition of your eyes during the exam.
These checks include:
A visual acuity and refractive status assessment: Your optometrist will determine your vision with and without correction and then perform a complete refractive assessment to determine the most accurate prescription for your glasses for clearest and most comfortable vision. A digital cutting-edge phoropter technology can be utilized instead of the conventional manual phoropter to perform the subjective part of refraction (this is sometimes referred to as the ‘better one or better two’ test).
Binocular assessment: A check to determine how well your two eyes work together as a team.
Accommodative assessment: Similar to the binocular assessment, this determines your eyes’ focusing ability at near and distant and during prolonged periods of reading and computer use. Your optometrist will also typically assess your vision for computer distance and other intermediate tasks.
Pupil assessment: A quick evaluation to determine how your pupils react to light and whether they have any physiologic or other anomalies that might be an indication of other health conditions such as nerve palsy and Horner’s syndrome.
Extra-ocular muscle function test: Determine the function of the muscles that help your eyes move in all directions.
Cover test: Assesses for misalignment in the eyes and detect early and advanced stages of eye turns (strabismus) or phoric disorders and improper binocular postures.
Visual field assessment: Assesses your peripheral vision. This test is done for different reasons and also has different modes. Manual confrontation test is typically done routinely for gross assessment, whereas more specific automated tests are done to assess for specific conditions such as glaucoma and brain tumours screening.
Intraocular pressure test: Assesses the pressure inside your eyes for indications of glaucoma or other disorders leading to elevated eye pressure.
Complete assessment of the anterior segment of your eyes: Your optometrist will examine the health of your eyes under the microscope (the slit lamp test) to determine if there any corneal or other anterior segment disease like conjunctivitis (pink eye) or other inflammatory eye disease or infections. Your doctor will also assess the lids and the adnexa for related medical problems.
Posterior segment disease: This test is typically done through the dilation of the pupil with drops to examine the retina, the optic nerve and the other structures at the back of the eye.
Retinal imaging: A highly detailed photograph and scan of the very back of the eye using a high powered camera. These scans aid the optometrists in assessing the psychical condition of structures like the macula, retina and retinal layers, the optic nerve head and surrounding tissues. These scans are provided to the patient after every exam for their records.
Emergency Eye Care: Our eye doctors are licensed to diagnose and treat eye diseases such as urgent pink eye, keratitis, also foreign body removal and management.
Check Yearly, See Clearly
Book your eye exams Toronto with our optometrists today at one of our 360 Eyecare locations in Toronto. We look forward to providing you with the complete circle of care for all your eye care and eyewear needs.
Eye Exam Tools and Technology
But hold on a moment. Phoropter? Visual fields? Retinal camera? There’s still a lot of terms here that can be confusing. Let’s break it down to some of the most common elements of an eye exam, shall we?
Visual Acuity & The Snellen Chart
The eye chart, officially known as the Snellen chart, is typically the first thing people think of when one says the phrase “eye exam”. The chart has several rows of letters of different sizes, with the largest letter on top and descending in size as you travel down the chart. Many patients recognize it for the big “E” at the top.
The Snellen chart is used to measure visual acuity. Its creator, Dr. Herman Snellen, created the chart in the 1860’s to help measure his patient’s visual ability when compared to what a “standard”, “healthy” or “emmetropic” eye is able to read from specific distances. The standard distance for acuity is six meters, or 20 feet, and by adjusting the size of the letters on the chart, it can simulate what something would look like at further or closer distances. The patient is asked to read lines on the chart, and their ability to do so is compared to the results of the “standard” eye; when paired together, the result is the patient’s visual acuity.
For example, if the smallest line a patient can read on the chart is the one designated as “20/40”, then that means that the patient must be 20 feet away to read what a “standard” eye can read clearly at 40 feet. This test is done with and without visual aid devices (glasses, contact lenses, etc.), and is used in conjunction with the phoropter to determine the refractive power required to get as close to 20/20 visual acuity as possible. Depending on a patient’s eyes, they may be able to achieve 20/20 acuity without visual aids, or with the use of visual aids.
What is Visual Acuity used for?
Visual acuity is used as an indicator as to whether a patient may require glasses to legally drive – without glasses a patient may only be able to achieve 20/80, but with glasses they can comfortably achieve 20/20, for example. Visual acuity is also used to help diagnose and legally define low vision, or blindness.
Over the years the eye chart has become digitized, allowing the optometrist to randomize the letters to prevent chart memorization by frequent patients. Digitizing the chart also allows the optometrist to flip through the acuity lines at the press of a button, and to easily highlight specific lines for patient’s to read. And with the use of mirror, the optometrist is able to use the chart without the exam room needing to be 20 feet in length, making the space more efficient.
One of the staple devices in the eye exam room, its design has had a few changes and modernizations as technology advanced. Also known as a refractor, the phoropter is typically mounted on an arm set up next to the exam chair that can swing and be manipulated in front of the patient’s eyes and face. The device contains many different lenses that can cycle in front of the patient’s eyes via manual or remote control. The optometrist is able to test and measure the patient’s refractive error by having the patient’s look through these lenses and evaluating how well they can see the eye chart at the other end of the room.
The phoropter contains lenses that help measure spherical power, astigmatism power and axis of rotation, and even prism power and direction. Older phoropters were controlled manually by the optometrist spinning specific dials while asking for subjective feedback from the patient as to the level of clarity of their vision with the current selection of lenses. Modern phoropters are controlled remotely with a separate control panel that can save multiple lens selections and combinations at once, allowing the optometrist to rapidly switch between lenses and hone in on the patient’s prescription. With the click of a button, the final readings can then be added to the patient’s chart and easily printed for – or even emailed to – the patient for their use.
While phoropters have been around since the 1910’s, their design and function as binocular refraction devices has changed very little, only becoming more efficient as technology has advanced.
The Slit Lamp
The second staple of an optometrist’s exam room, the slit lamp is a powerful binocular microscope that the optometrist will use to examine the physical structures of the eye and evaluate a patient’s eye health. With the patient’s head positioned on the chin rest and against the forehead rest, the optometrist is able look through the microscope and examine various points of interest from the front through to the back of the eye. The optometrist can examine the surface of the eye, the lids and the meibomian glands along the lid margins, or the tear film and evaluate its effectiveness.
By manipulating the powerful light attached to the unit, the optometrist can bounce light inside the eye to see a cross section of the layers of the cornea, examine the anterior chamber and the lens between the anterior and posterior chambers. With stronger magnification, the optometrist can look further through an appropriately sized pupil (typically dilated) to see the back of the eye, where the retina, macula and optic nerve head are.
The slit lamp will typically have several smaller devices attached to it that can swing into position as needed. This may include a smaller bright light to aid in achieving a highly detailed view inside the eye, or a tonometer to accurately measure the fluid pressure within the eye. While many devices and tools within healthcare have become digital and automatic, the slit lamp relies on the training and intricate manual control of the optometrist, and remains one of the most useful tools of diagnostics in the optometrist’s arsenal.
The Auto Refractor
One of the newer tools at an optometrist’s disposal, the auto-refractor is now a common element either in the exam rooms or during the pretest prior to the exam with the optometrist. It is a machine with a computer on board that uses light and a digital camera to give a rough measurement of the surface of a patient’s eyes. This provides the doctor with a general reading of the high points and low points of the surface of the eye (known as the keratometry or k-readings) which is useful when determining the best fit for soft contact lenses. The auto-refractor can also give a rough estimate of the patient’s starting or neutral refractive error. While it only provides a rough estimate, it provides a useful starting point for the optometrist in the exam room to work with in determining an accurate refraction and prescription for the patient.
Some auto-refractors are fitted with an additional device that uses a pin-point light to measure corneal thickness and ocular fluid pressure less invasively than older methods. The more memorable element of these auto-refractors is the “puff of air” that shoots out of the machine towards the patient’s eye. Sensors on the patient side of the machine then measure the pressure of the air that bounces back off the patient’s eye, and calculates the internal pressure of the fluids. This method of testing is considered to be preferred as it does not involve touching the patient or the eye, and can be done without administering numbing drops.
Auto-refractors can be manually controlled by a trained technician or staff member, or can be fully automatic and capable of switching between the patient’s eyes and its functions without operator input, making the pretesting stage quick and efficient.
The Retinal Camera
Another newer device that’s become a fixture for optometrists and ophthalmologists alike, the retinal camera is a powerful device with a custom camera system, microscope and onboard computer that is capable of producing high-quality images of the structures located within the back of the eye. Known as fundus photography, the image captured can show the retina, macula, optic nerve, and all the veins and vessels all at once and in impeccable detail.
While the slit lamp allows the optometrist to look at the same structures themselves, the photo is useful in seeing the whole of the rear of the eye as one image, and to see the normally small parts of the eye at a much larger scale and level of detail only available with digital photography. Fundus photography can help detect retina or vitreous tears, damage caused by diabetic eye disease, swelling of the optic nerve and the early warning signs of glaucoma.
Some cameras have also been modified with an additional scanning function, and using light waves are able to produce a cross section scan of the retinal layers and the macula. Known as the Optical Coherence Tomography, or OCT scan, the scans can help the optometrist detect changes in retinal layer thickness, detect separations or irregularities, and aid in diagnosing conditions such as macular degeneration or diabetic eye disease. OCT scans can help provide guidance for treatment plans for conditions like glaucoma.
The photos and scans produced by these retinal cameras have been invaluable in early detection of eye related diseases and conditions, and more and more optometrists are implementing them as a standard part of a regular exam.
The OCT (Optical Coherence Tomography)
Devices like the slit lamp and retinal camera allow optometrists a clear view of the back surface of the eye, but what if a diagnosis requires a deeper look? Conditions such as diabetic retinopathy and glaucoma can cause tissue damage within the layers of specialized cells that make up the retina, but that damage may not be visible on the uppermost layer. Age-related macular degeneration will cause the macula to become thinner over time, or cause abnormal blood vessels to grow and burst underneath the retina. So how can an optometrist look deeper within those retinal layers?
The OCT, or optical coherence tomography, is another type of imaging test that uses waves of light to capture a cross-section scan of the retina and macula area in the back of the eye. This allows the optometrist to look for changes in retinal layer thickness or density or for any abnormal growths or separation within the layers. It is not an x-ray and does not need to touch the eye at all for these scans, it is more comparable to a quick ultrasound using light instead of sound to produce a clearer image.
Because of the importance of the retina and macula, and the limited nature of regeneration or recovery from damage, the OCT has become the standard test alongside retinal imaging for patients diagnosed with or suspected to have diabetes, glaucoma and macular degeneration.
The Visual Fields Test
Though not as common as some of the other devices and instruments in this article, the visual fields test is just as important for the purposes of diagnosing severe conditions. The visual fields test measures the total width of a patient’s area of vision while they focus on a single point straight ahead, also known as the measure of peripheral vision ability in degrees. This test can detect any blind spots a patient might have, or a decrease in peripheral ability over time due to conditions such as glaucoma.
The ways the visual fields test is administered can vary depending on whether the optometrist or ophthalmologist wants to run a basic check or a more in-depth examination. The detailed visual field test involves the patient looking into a machine called a perimeter and staring at a predetermined fixed point on the screen inside. The patient is then instructed to press a button every time they see a blinking light or moving line appear somewhere else on the screen without looking away from the centre. The test is done per eye, with the untested eye covered for the duration, and can take anywhere from three to ten minutes to complete depending on the testing type.
In some cases, a patient may only need to have visual field screening once. Other patients may need regular screening on a yearly or bi-annual basis. Certain jobs and careers require a visual field test as a part of their application process, and at least a basic visual field screening is required for new drivers getting their license in Ontario. Should you find yourself requiring a visual field test for any reason, a quick call to your regular optometrist to see if they provide that testing is recommended.
Eye Exam FAQ
Firstly, if you are considering an eye exams in Toronto but still have questions or things you want to clarify, rest assured, you are not alone. Based on the questions we received over the many years we’ve examined, diagnosed and treated eye conditions in the Toronto area, we’ve come up with a list of the most Frequently Asked Questions regarding eye exams toronto. However, if you still have questions after consulting our FAQs, do not hesitate to contact us via phone, email or by also using our website.
Usually, these exams are covered by your private vision or health care plan. Your eye exam will be cover by OHIP if you are 65 and over, 19 and under or have specific conditions that are deemed insurable by OHIP. Please call our office to inquire further.
This depends on your age and previously diagnosed conditions, but a good rule of thumb is to have your eyes regularly checked every 1 to 2 years. The sooner we can spot conditions that require attention, the easier it is to correct.
Knowing when to visit an eye doctor to get your eyes checked is important. Not only is this information valuable, but it could also save you from potentially developing advanced eye conditions that might not have symptoms at early stages. Only your optometrist can determine how frequently you should be seen for eye examinations.
However, the Canadian association of optometrists recommends the following as the minimum frequency for routine eye examinations: Infants and toddlers should undergo their first eye examination between the ages of 6 and 9 months. Preschool Children 2 to 5 years of age should undergo at least one eye examination in this period. School children aged 6 to 19 years should undergo an eye examination annually. Adults aged 20 to 39 years should undergo an eye examination every 2 to 3 years; Adults aged 40 to 64 years should undergo an eye examination every 2 years; Adults aged 65 years or older should undergo an eye examination annually.
The risk of developing ocular disease is higher at 65 years of age and older. Our doctors at 360 Eyecare in Toronto strongly advocate for following the recommended frequency of visits by your optometrist. These exams will detect early signs of many age-related eye diseases such as glaucoma, cataracts, and macular degeneration.
We try to cater to our patient’s need; thus, we will try to accommodate you as soon as possible. We also have appointments outside of working hours and on Saturdays, so you can have lots of possibilities of scheduling you eye exam in the Toronto area.
Although not a lot of preparation is required, please be ready to answer questions about what prescription drugs you use and relevant family history. Also, if you currently wear glasses or contact lenses, please bring them with you. Lastly, if your exam requires your pupils to be dilated, we advise having someone else to drive you home.
Eye exams can take up to 40 to 50 minutes depending on the tests needed to be done. Most exams are completed in 20 to 40 minutes. Please allow extra time if you are a new patient and require to fill paperwork before your examination.
Although we do accept most types of vision and health insurance plans, it’s best to ask a few days in advance or when booking your appointment so we can check for you ahead of time.
There is no easy and clear answer for this question. After your eye exam is completed, your optometrist and optician will recommend the type of lenses you would need. The price will depend on your prescription and also on the type of lenses you require.
The Importance of Eye Examinations
As you can see, the eye exam has come a long way from the early days as technology has advanced, allowing doctors to assess and evaluate ocular conditions earlier than they had in the past. And with early detection comes early treatment and management. A thorough modern eye examination is just as important for your overall health as your yearly physical with your family doctor. It is important to note that not every eye examinations offered will have all of these instruments and checks, so it is important to inquire ahead of time as to what the eye exam consists of and whether that is right for you and your needs.
Don’t see your question answered here? Feel free to contact us via phone, email or by also using our website, or even drop by one of our Toronto offices and chat with us in person. We are more than happy to help.
At 360 Eyecare, we believe in offering our patients the full scope of eye health needs, and our comprehensive eye exams reflect that vision. Please reach out to either of our locations to book your next eye exams toronto today: 360 Eyecare – Rosedale or 360 Eyecare – Beaches.