An eye examination has two important functions. The first is to assess the health of the eyes and to detect any general health problems that may be reflected in the eyes. For example, diabetes and high blood pressure can be detected in an eye examination. The picture on the right shows one of our optometrists, Dr Claire O’Leary, using a binocular microscope to examine the front of the eye under high magnification. We also have special equipment for scanning and photographing the back of the eye and this equipment is described below. For the pressure test, we use a modern instrument (pictured below) which measures the pressure without blowing a puff of air at the eye. Many of our patients tell us that this is the best investment in equipment that we have ever made!
The second function of the eye examination is to assess how well the eyes see. If there is a problem with the visual or optical performance then we prescribe glasses, contact lenses, or eye exercises. During this part of the eye examination the optometrist typically asks lots of questions, such as ‘Which is clearer, lens one or lens two’. Patients are often concerned that they might answer the wrong question, but there is no need to worry about this. Each question the optometrist asks is repeated three or four times and the average response is recorded. This is not because the optometrist does not trust the patient, but rather because they know how difficult it is for the patient to be sure. By double-checking and treble-checking, the optometrist can be completely confident of the result obtained.
The assessment of the functioning of the eyes is not just about the optics of the eyes, or how well the eyes focus. Several of the tests that optometrists carry out are designed to assess how well the eyes work together as a team. This is sometimes called the binocular co-ordination, or orthoptic function. Our principal optometrist, Professor Bruce Evans, has specialised in this subject and has written several textbooks on this and designed a system of eye exercises.
Although the practice has records for over 35,000 patients, we are committed to providing personalised care. When our patients return for an appointment, we are usually able to arrange this with the optometrist who they saw last time. Indeed, our three senior optometrists have between them worked at the practice for 70 years.
One challenge with over 35,000 patients is keeping an accurate record of your eyes, spectacles, and contact lenses. We have had a computerised reminder system since 1996, but in 2006 we invested in a new state of the art system. This is produced by the leading company that specialises in software for optical practices and allows full integration of our eye examination records, reminder system, spectacle dispensing, contact lens ordering, and even the sketches, photographs, and scans that we take of your eyes. Of course, your details are password-protected for confidentiality and regular back-ups are made of all the data.
Parents often ask at what age children should have their first eye examination. Usually, it is best to start eye examinations between the ages of about one and two years. A common mis-perception is that children need to be able to read before they can have an eye examination. This is not the case, and all our consulting rooms have state of the art computerised letter charts, which let us use a range of child-friendly targets including those illustrated in the right. These charts also allow the optometrist to randomise the order of the letters, so that children can now no longer memorise the optometrist’s letter chart! We use lots of tests, that are presented as interesting ‘games’, many of which do not require any participation from the child (other than being awake!).
One problem that parents can watch for is a turning or wandering eye. This is illustrated in the photo on the left. An occasional ‘wandering eye’ in the first three or four months of life is quite common, but should cause concern if it is starts happening more frequently. After the age of about four months, any turning eye is an indication for an eye examination. All our optometrists can examine pre-school children, and most provide this care to eligible patients under the NHS (see below).
Most adults reading this will have had their vision screened regularly at school throughout their school years. Amazingly, this was stopped in the UK a few years ago and in most regions vision is no longer tested at school. This is despite the fact that many visual problems can develop during the school years and children often do not realise that their sight is gradually deteriorating. It is therefore important for school children to have regular eye examinations with an optometrist. Again, these eye examinations are available with most of our optometrists funded by the NHS. Even if a child’s vision has been tested at school the screening tests do not detect all the eye problems that could be detected in a full eye examination with an optometrist. This is one reason why it is recommended that all children have regular eye examinations.
One area of children’s community eyecare that is still not funded by the NHS is a comprehensive assessment of visual factors that may be associated with specific learning difficulties. Our principal optometrist, Professor Bruce Evans, is a world authority on this subject and the testing that these children require is described in more detail in the section on difficulties at school. It is not necessary for children to have received a diagnosis such as dyslexia in order to have these tests.
The modern eye examination
The eye examination has developed in sophistication over the years and new techniques have improved our ability to determine the correct spectacle prescription. But the greatest improvement has been in our ability to assess the health of the eyes.
There are over 50 tests that could be included in an eye examination today. Clearly, a large part of an optometrist’s skill is to determine which tests are appropriate.
The core eye examination
The basic core elements of an eye examination are listed below:
There are also many additional tests that can be carried out, when appropriate. Some of these are described below.
Items included in an NHS sight test
All the tests listed above are included in our NHS eye examination. At Cole Martin Tregaskis both the pressure test and the visual field screening test for glaucoma are included in all NHS sight tests for people over the age of 40. An NHS sight test is intended for determining whether a patient requires glasses and is available for children, people over 60, those on low income, and certain people with or at risk of glaucoma or with diabetes. The NHS HC11 form gives details of eligibility. The NHS sight test is not appropriate for emergency appointments.
With the exception of Professor Evans, all our optometrists see NHS patients, but Dr O’Leary and Mrs Shah have some days when they only see private patients.
The reasons why a growing number of optometrists are limiting the provision of NHS services relates to optometrists’ NHS contract, which in England is very limited in scope and now has fallen behind the situation in Scotland and Wales. The main problem is that in England the NHS pays a fixed fee of about £20 per sight test, and does not pay anything extra for additional procedures. This fee covers less than half the cost of providing a modern, thorough, eye examination. Here at Cole Martin Tregaskis Optometrists our reputation means that we receive many referrals of patients with complex ocular problems. Consequently, we spend more time than average on an eye examination. Also, the NHS pays the same fee for a sight test by a newly qualified optometrist as they do for an optometrist with 20 or 30 years experience. Professor Evans only sees patients privately and this means that an NHS Optical Voucher for spectacles cannot be issued following one of these appointments.
Follow-up tests and the NHS
Occasionally, an NHS eye examination may detect a problem which requires additional testing. The NHS in England does not usually fund these follow-up tests and the appropriate private fee is shown below. In 2011 the NHS in Essex started funding a scheme involving selected optometrists who have been engaged to see patients in community practices with certain conditions (e.g., suspected glaucoma) that would in the past have required referral to the hospital eye service. Cole Martin Tregaskis Optometrists have participated in this and subsequent schemes since their inception. Our staff will advise on whether this is appropriate for you.
Optical coherence tomography and fundus photography
Technological developments in ocular photography have made it possible to detect eye diseases sooner and to monitor eye conditions with much greater accuracy. We were one of the first practices to invest in this new technology when we bought our first fundus camera in 1999, which was upgraded in 2007.
In 2011 we became the first practice in the area to buy an Optical Coherence Tomography instrument (OCT; illustrated below). This state of the art equipment gives a 3-D scan of the structures inside the retina and more information is given our leaflet on OCT. Photography & OCT are not covered by the NHS sight test fee. We recommend that all adults have photos and OCT scans, especially during COVID-19. The charges for NHS patients are given below. Please let reception know when you arrange the appointment if you would like OCT scans. OCT scans are not usually required for children.
Updated November 2023