Comprehensive Eye Exams
Routine eye exams are important even when our eyes and vision seem fine. This is because many blinding eye diseases have few or no warning signs until it is too late, and they have taken away some or all of our vision.
Diabetic Eye Disease, Glaucoma and Age-Related Macular Degeneration are just a few of the eye diseases that can blind you without you even knowing you have them. Finding eye diseases as early as possible gives you the best chance of saving your sight. If you haven’t had an exam for more than a year, book one now.
- Infants should have their first eye examination at or by 6 months of age.
- Children should have their first eye exam, including a measurement of vision, around age 3 before starting kindergarten. Their vision should be measured at least every few years to make sure their sight is developing normally.
- Teens should have an eye exam every two years and especially before beginning to drive, to make sure they will be safe behind the wheel.
- Adults should have an eye exam every year or two beginning at age 40, and at least once a year after age 50.
- Under South Carolina law, contact lens wearers must have annual eye exams.
- People with diabetes should have an eye examination every year starting when they are diagnosed with diabetes, no matter how old they are.
- People whose relatives have eye disease, such as glaucoma or macular degeneration, should have eye examinations once a year beginning as early as age 30, to monitor for any signs of disease.
There are essentially two types of insurance plans that cover eye exams: vision insurance and health insurance plans. Many people are confused by the difference between them when it comes to paying for their eye exam.
It is little wonder, as there are so many different permutations to the two types of plans, with different deductibles, co-pays and levels of coverage. To help you understand what exams are generally covered under which type of plan, we’ve developed this FAQ based on questions our patients often ask us.
The biggest difference is that vision plans cover “routine eye exams”, glasses and/or contact lenses, whereas medical insurance plans do not. Medical insurance plans cover disease or injury to the eye, and therefore generally cover only “medical eye exams”.
There can be similar steps and tests within both types of exams, but insurance companies focus on the reason for your visit to an eye doctor to determine your coverage.
It really depends on your “chief complaint” – that is, why you want to see an eye care professional in the first place. If you want to book an annual eye exam, or wear glasses and think you may need your prescription updated, then you would book a routine eye exam, which your vision plan would cover. However, if you also have a medical problem, such as itchy, dry, burning eyes, then that would NOT be covered by your vision plan. We would file a medical claim for treatment of any medical problem.
A routine eye exam involves a series of different tests and usually produces a diagnosis of nearsightedness, farsightedness, astigmatism or presbyopia, along with a prescription for corrective eyeglasses or contact lenses, if required.
If you don’t have a vision plan, you must pay for your routine eye exam out of pocket at the time of the exam.
If you are suffering from an eye disease or condition, such as glaucoma or diabetic retinopathy, or suffer from dry eye or have an eye injury, then you would book a medical eye exam. The medical exam would be covered by your health insurance plan. Again, if you don’t have health insurance coverage, you would have to pay for the exam out of pocket or use our payment plan.
Note if you ever incur an eye injury, call our office immediately and you’ll be seen as soon as possible. After regular office hours, phone 855‑654‑2020 and press 5; the “doctor on call” will return your call promptly. Alternatively, call the emergency department at your nearest hospital.
If you booked a routine eye exam, your eye doctor will complete that exam and your vision plan would be billed. Your doctor will then schedule a follow-up medical eye exam to do additional tests and diagnose the possible eye disease. The follow-up medical eye exam would be billed to your health insurance plan.
Yes, or more frequent exams if your doctor deems them necessary, but once you are being treated for a medical eye condition, you would be booked in for a medical eye exam, and your health insurance would be billed.
A refraction is an essential part of a comprehensive eye exam that determines your eye’s best vision and prescription. It is the test where the doctor asks: “Which lens is better, one or two”? It measures nearsightedness, farsightedness, astigmatism or presbyopia. The doctor places an instrument called a phoropter in front of your eyes. You are shown a series of lens comparisons and indicate which is clearer. The results of the test are used to develop your prescription and monitor any changes in your vision.
If a patient is experiencing blurred or decreased vision, refraction determines if this is due to a need for corrective lenses or a medical problem. For patients anticipating cataract surgery, a refraction is required to prove that vision cannot be corrected with glasses and eye surgery is medically necessary. Patients who have a refraction will receive a new prescription valid for one year.
Our doctors consider refraction a critical component of any eye exam. It is the best way to monitor any changes in your vision over time.
Typically, vision plans cover both the eye exam and the refraction component. However, most health plans only cover the exam, and not the refraction.
Our fee for a refraction is $80, but we offer a $30 adjustment when it is paid directly at check-out (net fee is $50). If you do not have vision plan coverage for a refraction, you will have to pay for it at the time of your appointment. If you have coverage through a vision plan, we will bill your insurer.
Medicare, Medicaid, and private Health Insurance Plans generally do not cover “routine” eye exams or refraction fees. They are designed to cover the diagnosis and treatment of medical eye conditions and diseases.
If you or members of your family need corrective eyewear, you should consider purchasing a vision plan as they can save you considerable amounts on eye exams, glasses and contact lenses. Some vision plans also provide discounts for Lasik, PRK and other services with their contracted providers. Clemson Eye ia a contracted provider for a wide array of insurance plans.
Whether it is routine or medical, a comprehensive eye exam costs from $60‑$200, depending on the tests required. All co‑pays, deductibles, and shared costs are payable on the date of service. If you do not have insurance coverage, you are required to pay for your eye exam at the time of your appointment.
A comprehensive, dilated eye exam is the best way to protect your eyes and visual health over time. It’s important to know that many eye diseases have no symptoms until it is too late and vision has already been permanently lost. But if eye diseases, such as glaucoma, macular degeneration, cataracts, or diabetic retinopathy, are detected early enough, they can be treated and vision can be saved. We strongly encourage you to have a regular eye exam.
A comprehensive eye exam generally takes an hour and includes most of the following tests:
- Visual Acuity
Measures the sharpness and clarity of your vision. Your eye doctor will ask you to read letters on a chart. The smallest letters you are able to read will be recorded as your acuity.
- Confrontation Visual Fields
Checks your basic field of vision, including your central and peripheral vision. Your eye doctor will sit in front of you and ask you to cover one eye. You will then be asked to say when you can see their hand as it enters your field of vision from the sides.
- Extraocular Movements
Measures the muscles that control eye movement. It is a simple test conducted by moving a pen or like object in different directions. Visual restrictions, weaknesses or poor eye tracking can be discovered through this test.
- Pupillary Reactions
Tests the way your pupils dilate and constrict in response to light. This is an important test that can reveal a lot about the health of your eyes and body. The nerves that control the pupil travel through a long pathway within the body. Certain pupillary reactions can reveal neurological problems, including some serious conditions such as Horner’s Syndrome.
- Cover Test
Measures how well your eyes work together. The doctor will ask you to fixate on a near or distant object. He then covers one of your eyes, pauses, and uncovers it. The test evaluates your eye as it is uncovered and “refixates” on the object.
Helps measure refraction. Usually performed early in an exam, the retinoscopy provides a starting point for your eye doctor to estimate your prescription for glasses.
Measures nearsightedness, farsightedness, astigmatism or presbyopia. The doctor places an instrument called a phoropter in front of your eyes. You are shown a series of lens comparisons and asked to indicate which is clearer. The results of the test are used to develop your prescription and monitor any changes in your vision over time.
- Slit Lamp Examination
Examines the front and back of your eye. The instrument magnifies your eyes many times and uses a bright light to illuminate the eye’s anatomy. Each part of your eye, including your eyelids and eyelashes, conjunctiva, cornea, iris, crystalline lens and anterior chamber, is examined to reveal any defects or diseases. Cataracts can be diagnosed using the slit lamp.
Measures the eye’s intraocular pressure or IOP. Your eye doctor will put a drop of anesthetic into your eye and then place a small amount of fluorescein (yellow dye) into your eye. A small device called a tonometer is moved close to your eye so that it gently touches the cornea, measuring the pressure of your eye. If your eye pressure is higher than normal, you are at risk of developing glaucoma, the second leading cause of blindness in North America. Another method is the “air puff” test, where a non-contact tonometer determines eye pressure with a light, painless puff of air.
Usually the last step in a comprehensive eye examination. Your eye doctor will administer eye drops to dilate your pupils. This increases the size of your pupil, giving your doctor a larger view into your internal eye health. Through this test, the doctor can examine the optic nerve, vitreous, blood vessels, macula and retina. Note the dilation will last up to 24 hours, depending on the types of drops your doctor uses and the color of your eyes.
No one’s denying that figuring out health insurance coverage can be confusing. We at Clemson Eye are knowledgeable about coverage and will do our best to help you understand your particular plan’s benefits. However, it is your responsibility to understand your coverage, including any deductibles and co-pays. When in doubt you should review your policy carefully and/or contact your provider with your specific questions.