• COMPREHENSIVE MEDICAL EXAMS

A detailed examination of the eyes & visual system, including diagnosis & treatment plans for any eye related medical conditions.

Medical insurance can be billed for this type of visit (specialist copays & deductibles may apply)

Total Vision Care (TVC) is in network with most major medical insurances

(see list of insurances accepted) 

Fees vary depending on the complexity of the exam

Self pay patients - call for an estimate of fees based on the service needed

PURPOSE OF A COMPREHENSIVE MEDICAL EYE EXAM: Clear vision is not just about having the right glasses prescription.  To achieve clear vision, a healthy eye and well functioning visual pathway is necessary. If any part of the visual system is disturbed, vision may be impaired. A comprehensive medical exam includes the testing & evaluation necessary to determine any potential causes of reduced vision. 

WHO NEEDS A MEDICAL EYE EXAM?

  • All patients over age 60 are advised to receive annual medical exams due to the risk of medical problems including cataracts, glaucoma, dry eyes, and age-related macular degeneration.
  • Patients at any age who have been diagnosed with a medical problem are advised to keep regular follow up visits as recommended by the eye doctor to monitor the condition being treated.
  • Patients under age 60 should receive routine vision exams regularly and follow the recommendations of their eye doctor for follow up comprehensive exams as needed.

HOW IS A MEDICAL EXAM DIFFERENT THAN A ROUTINE VISION EXAM?

  • A medical exam includes all the aspects of a vision exam EXCEPT a refraction (a "refraction" is when you look through the phoroptor and are asked "which is better number one or number two?" and the result is given in the form of a glasses prescription).
  • In addition to examination of the eyes, certain tests may be ordered to aid in the diagnosis and treatment of some medical conditions.

Total Vision Care has invested in some of the most advanced testing equipment in order to provide the best medical care available for primary eye care management. If more detailed testing or treatment is necessary, appropriate referrals will be made.

 

 PARTS OF THE EYE THAT REQUIRE DETAILED EVALUATION DURING A COMPREHENSIVE MEDICAL EYE EXAM:

DRY EYE SCREENING

DEFINITIONThe front surface of the eye needs to be kept moist to maintain clear vision & good ocular health. If the tear film is inadequate, vision can fluctuate & dry spots can cause tiny "cracks" on the surface leading to eye pain, burning, increased risk of infection, & scarring of the cornea. The tear film is complex with multiple layers involved.

CONDITIONS:

  1. Evaporative Dry Eye Disease- This is a condition that results when the meibomian glands of the eyelids are damaged or inflamed. The oil layer is insufficient to reduce tear evaporation causing the cornea to become dry. 
  2. Tear Film Insufficiency- This is a dry eye disease caused by reduced production of tears from the lacrimal glands. 
  3. Keratooconjunctivitis Sicca (inflammatory dry eye disease)- This is dry eye disease that results from inflammation to the surface of the eyes, eyelids, & lacrimal glands. This is often a more severe form of dry eyes & requires aggressive management to reduce risk of damage to the surface of the eyes.

There are multiple causes of dry eye disease including aging, hormone changes, medication side effects, environmental factors, excessive use of electronic devices, use of harmful eyelid cosmetics, & dehydration.

CATARACTS

DEFINITION: The focusing lens of the eye can become cloudy causing blurry or dim vision, reduced night vision, reduced contrast or color perception, & increased glare.

CONDITIONS: 

  1. Age related Cataracts- if we all live long enough, we will develop cataracts (a gradual clouding of the lens)
  2. Traumatic Cataracts- a blunt trauma to the eye can cause a fast growing cataract to develop within days or years after the injury
  3. Hereditary Cataracts- some families have a hereditary tendency to develop cataracts at a younger age
  4. Juvenile Cataracts- these occur as an infant and can cause permanent loss of vision is not addressed quickly
  5. Congenital Cataracts- these often do not cause any symptoms and are more appropriately a "birth mark" on the lens
  6. Diabetic Cataracts- Diabetics can develop a fast growing cataract due to the effect that blood sugar fluctuations have on the lens
  7. Steroid induced Cataracts- steroids can cause a fast growing cataract that causes an effect like a "finger print smudge" on the lens

INTRA-OCULAR PRESSURE (IOP)

DEFINITION: IOP is a measurement of the pressure inside the eye. The eye is like a water balloon that is always making new fluid & draining out the old fluid. If, for any reason, the eye is not able to drain the fluid out as fast as it makes new fluid, the eye fills up too full which causes increased pressure. This can damage the optic nerve leading to permanent loss of vision.

CONDITIONS:

  1. Hereditary Glaucoma- this is a general term for a slow progression of damage to the optic nerve. Generally this can be caused by increased IOP, however in some cases damage can occur even when IOP is "normal". It is important to have regular eye exams with the same doctor or have your records transferred if you move so your eye doctor can monitor for increases in your "normal" IOP.
  2. Traumatic Glaucoma- injury to the eye can cause the IOP to increase leading to a secondary type of glaucoma.
  3. Steroid Induced Glaucoma- some patients can be "steroid responders" meaning their IOP increases when they take steroids of any kind (nasal sprays, inhalers, steroid injections, oral steroids, or steroid eye drops).
  4. Inflammatory or Pigmentary Glaucoma- conditions such as "Uveitis" or "Pigmentary Dispersion" can cause the drainage system to become clogged leading to increased IOP & a secondary type of glaucoma.

 

 

 

CORNEA

DEFINITION: The clear front part of the eye that allows light to enter the eye. The cornea is the part that a contact lens covers & is responsible for some focusing power of the eye. If the cornea is damaged or irregular, this affects clarity of vision similar to the effect of wearing scratched or cloudy glasses.

CONDITIONS:

  1. Corneal Dystrophy or Degeneration- a condition that causes progressive changes to the clarity of the cornea. This can be hereditary & cause changes to your prescription for glasses.
  2. Corneal injury (abrasion or scar)- A scratched cornea can be very painful & cause light sensitivity & blurred vision. If it is not treated appropriately, it can become infected and/or cause permanent scarring leading to decreased vision.
  3. Keratitis- inflammation of the cornea due to infection (bacterial or viral) or dry eye disease
  4. Keratoconus- a type of hereditary corneal degeneration that causes the cornea to become cone shaped and thin. This causes dramatic shifts in prescription & can eventually cause reduced vision unless treated before the condition becomes severe.

CONJUNCTIVA

DEFINITION: The clear membrane covering the white part of the eye & the inside of the eyelids.

CONDITIONS:

  1. Follicular or Bacterial Conjunctivitis- infection commonly known as "pink eye" can cause itching, burning, redness, swelling, yellow or green discharge, matting of the lashes (matted shut in the mornings), light sensitivity, blurred vision, & pain.
  2. Allergic Conjunctivitis- symptoms can be confused with infection, commonly associated with other signs of allergies as well as redness, itching, watering, clear mucus discharge, swelling, & blurred vision.
  3. Laceration- scratched conjunctiva
  4. Subconjunctival hemorrhage- bruising of the conjunctiva can cause bleeding between the clear membrane & the white part of the eye.
  5. Cancer- melanoma & other skin cancers can grow on the conjunctiva
  6. Pinguecula or Pterygium- scar tissue on the conjunctiva (pinguecula) or scar tissue that spreads on to the cornea (pterygium)

EYELIDS

DEFINITION: The eyelids include the skin surrounding the eyes and the eyelash margins. The eyelids have multiple oil glands (meibomian glands) that secrete an oil layer that coats the tear film to reduce evaporation of the tear layer.

CONDITIONS:

  1. Skin cancers or benign skin tags
  2. Loss of eyelashes
  3. Meibomian Gland Dysfunction (MGD) or Blepharitis- inflammation of the lids/lid margins
  4. Ectropion (lid margins turning outward)
  5. Entropion (lids margins turning inward)
  6. Ptosis (drooping of the eyelids)

ANGLE EVALUATION

DEFINITION: The "angle" in the eye is the part responsible for draining fluid out of the eye.

CONDITIONS:

  1. Narrow Angles- If the angle narrows, IOP can slowly increase leading to Chronic Narrow Angle Glaucoma.
  2. Angle Closure Attack- If the angle closes completely, IOP spikes quickly leading to severe headaches, nausea, vomiting, & can lead to permanent loss of vision if this is not treated within hours.

OPTIC NERVE

DEFINITION: The optic nerve is one of the main cranial nerves that extends from the brain to the back of the eye. Once the optic nerve enters the back of the eye, it sends billions of nerve fibers along the retina to aid in receiving light and transporting this information back to the brain to be interpreted as vision. Any damage to the optic nerve causes loss of vision & in some cases blindness.

CONDITIONS: 

  1. Injury- blunt trauma to the eye can damage the optic nerve
  2. Glaucoma- progressive damage due to increased IOP or reduced blood flow & circulation to the nerve
  3. Optic Neuropathy or Optic Neuritis- Inflammation of the nerve caused by increased intra-cranial pressure, increased cerebral spinal fluid pressure, tumors, circulatory problems from hypertension, diabetes, & atherosclerosis, or other conditions such as Multiple Sclerosis or Thyroid Disease.
  4. Stroke- a stroke can occur in a portion of the brain that includes the nerves leading to the eye. If the optic nerve is affected, loss of vision results. If the nerves leading to the eyelids, iris muscles (pupil dilator/sphincter), or extra-ocular muscles (muscles that control eye movement) are affected by a stroke, then other symptoms may occur (such as droopy eyelid, pupil changes, double vision).

MACULA

DEFINITIONthe part of the retina responsible for central, detailed vision. When the macula becomes damaged, central vision can become blurry, distorted, or missing areas can form.

CONDITIONS: 

  1. Age Related Macular Degeneration- a progressive degeneration of the macula associated with aging, heredity, UV/Blue light exposure, smoking, & poor diet
  2. Hereditary Macular Dystrophy- a hereditary degeneration of the macula that can occur at any age
  3. Macular edema- fluid build up/swelling in the macula that can be associated with diabetes, ocular surgery, & high myopia
  4. Macular hole- a thinning of the center of the macula that can occur spontaneously & be partial thickness or full thickness
  5. Epiretinal membrane (macular pucker)- a film that forms on the surface of the macula causing wrinkling of the retina
  6. Macular scar- this can occur after trauma, inflammation, or infection (ocular or systemic)

RETINA

DEFINITIONThe retina is a thin membrane in the back of the eye that includes the macula (central detailed vision) & peripheral retina. If any portion of the retina is damaged, portions of the visual field will be reduced or missing. The retina has many layers including the nerve fiber layer from the optic nerve.

CONDITIONS: 

  1. Retinal Tear- a tear in the retina causes an increase in flashes/floaters & can increase the risk of retinal detachment
  2. Retinal Detachment- a detachment causes loss of side vision & can lead to blindness if not surgically repaired within days
  3. Retinopathy of Prematurity- when an infant is born prematurely, the eyes have not finished developing & the retina may not finish forming
  4. Retinitis Pigmentosa- a hereditary degeneration of the retina that causes progressive loss of side vision & blindness
  5. Myopic Degeneration- high myopia (extreme near-sightedness) increases the risk for ocular complications such as a retinal detachment
  6. Retinal Nevus- a freckle in the retina that is benign & non-progressive
  7. Malignant Melanoma- a malignant cancer in the retina 
  8. Retinitis- inflammation of the retina often due to infection or systemic diseases

VITREOUS

DEFINITION: the gel that fills the majority of the eye (like a water balloon) & is attached to the retina in several places

CONDITIONS: 

  1. Posterior Vitreous Detachment (PVD)- a normal aging change that causes the vitreous to shrink & pull away from the retina causing flashes of light & floaters. In rare cases this can cause a retinal tear leading to a retinal detachment.
  2. Vitreous floaters- strands of tissue floating in the vitreous (this can occur at any age & generally is non-progressive)
  3. Vitritis- inflammation of the vitreous due to infection or systemic disease
  4. Vitreous hemorrhage- bleeding in the vitreous often caused by trauma or retinopathy

RETINAL VASCULATURE

DEFINITIONthe vessels in the retina are important for transporting blood supply to the retina & ensuring good vision. High blood pressure, high cholesterol, atherosclerosis, & diabetes can affect the blood supply to the retina causing vision loss. Patients with these conditions require regular dilated exams to monitor for blockages or bleeding in the retina.

CONDITIONS: 

  1. Diabetic Retinopathy- vascular changes including blockage & bleeding in the retina caused by fluctuations in blood sugar levels
  2. Hypertensive Retinopathy- vascular changes including blockage & bleeding in the retina caused by elevated blood pressure
  3. Ischemic Retinopathy- reduced blood flow to the retina caused by hardening of the arteries or cardiovascular disease
  4. Retinal Vein or Artery Occlusion- a blockage of an artery or vein that provides blood flow to the retina

INFLAMMATORY DISEASES

Auto-immune diseases such as Lupus, Rheumatoid arthritis, & Crohn's can cause inflammatory problems with the eyes including inflammatory dry eyes, uveitis, episcleritis, scleritis, posterior uveitis, & keratitis. Patients with auto-immune diseases require regular dilated exams and close monitoring for any complications from their disease or medications.

DEFINITIONAuto-immune diseases such as Lupus, Rheumatoid Arthritis, Crohn's Disease, & Sjogren's Syndrome can cause inflammation in the eyes leading to symptoms such as light sensitivity, eye pain, redness, & decreased vision.

CONDITIONS: 

  1. Conjunctivitis- inflammation of the conjunctiva
  2. Keratitis- inflammation of the cornea (this can damage the cornea)
  3. Episcleritis/Scleritis- inflammation of the white portion of the eye (this can spread leading to vision loss)
  4. Uveitis/Vitritis- inflammation inside the eye affecting multiple tissues in the eye
  5. Retinitis- inflammation of the retina
  6. Keratoconjunctivitis Sicca- inflammatory dry eye disease
  7. Sjogren's Syndrome- auto-immune disease causing dry eye & dry mouth

SYSTEMIC MEDICATIONS

DEFINITIONSystemic medications can sometimes cause problems with the eyes & vision. There are several medications (prescription & over-the-counter) that can cause visual side effects and/or damage to the eyes.

CONDITIONS: 

  1. Antihistamines/Decongestants
  2. Anti-depressants/Anti-anxiety medications
  3. Anti-seizure medications
  4. Bladder control/prostrate medications
  5. Chemotherapy/radiation treatment
  6. Auto-immune medications
  7. Migraine therapy
  8. Pain medications
  9. Erectile dysfunction medications
  10. Acne medications
  • Medical insurance does not allow a refraction to be bundled in with a medical eye exam.
  • We only charge $35 for a refraction ($45 for new patients receiving the first refraction from our office).
  • A refraction can be performed during your medical exam unless there are issues that can affect the accuracy of a prescription.
  • Once the medical conditions are stabilized, a refraction can be performed during a follow up visit or you can schedule a "refraction only" visit.