The Exam Experience

Step One- Case History

Patients are asked to provide details of previous eye care and what kinds of problems they may be having with their eyes or eyewear at present. A list of eye diseases in the family and a current list of medications must be provided to insure proper care. An analysis of the habitual eye wear is by checked by computer.

 

 

 

 

 

 

 

Step Two- Corneal topography

Topography is performed to determine the curvature of the front surface of the eye. This instrument measures irregularities that may cause astigmatism, keratoconus (buldging of the cornea) and dry eye.

 

 

 

 

Step Three- Auto Refractor

Developed by NASA, this instrument provides a very accurate measure of the patient’s distance prescription. The test is totally objective (does not require patient response), painless and very quick. The results are used as a starting point for the refraction (determination of the accurate prescription for myopia (nearsightedness), hyperopia (farsightedness), astigmatism, and presbyopia (used for reading glasses or bifocals).

 

 

 

 

 

 

 

Step Four- Refraction

This subjective procedure is done by Dr. Hawkins by systematically presenting a series of lenses to the patient for comparison. The patient is asked the old “which is better” to determine which lenses the patient feels provides the best vision. A comparison is now made to the objective and subjective and the final prescription is written.

 

 

Step Five- Specular Microscopy

Photographs are taken of the endothelial (inner surface) cells of the cornea. This very powerful (400x) camera provides an image to a computer that counts and analyzes these cells. Determination is made to see if the cells are healthy or if they have been damaged by trauma, chronic dry eye or prolonged contact lens wear.  At this point drops are instilled to dilate the patient’s pupils.

 

Step Six- Visual Field

Peripheral vision is tested to determine the efficiency of the visual pathways leading to the brain from the eye. Retinal detachment, macular degeneration, brain tumors, glaucoma, etc… will show up at this point.

 

 

 

Step Seven- Retinal Photography

Photos are then taken of the back side of the eye and any abnormalities are discussed with the patient, such as diabetes, high blood pressure, glaucoma, macular degeneration, etc… These photos are stored on the hard drive of this computer for future reference.

 

 

 

Step Eight- Dry Eye Testing

Drops are now applied to determine the health of the anterior segment of the eye. Dry eye syndrome. meibomian gland disease, conjunctivitis and allergic response all may require medications or other treatment.

 

 

 

Step Nine- Glaucoma (IOP’s)

A mild anesthetic is now dropped inside the lower lid and Goldmann tonometry (the standard of care) is performed to determine the amount of pressure inside the eye, The eye is very lightly and briefly touched and no puff of air is used.

 

 

 

 

 

 

Step Ten- Middle and Posterior Segment Evaluation

The eyes are now inspected by binocular microscope to determine the presence of cataracts, macular degeneration, retinal detachments, etc. All tests results are shown to the patients by photographs taken by Dr. Hawkins. Again all photos are stored on the hard drive for future reference.

 

 

Step Eleven- Pachymetry

An ultrasound is then taken to determine the thickness of the cornea. Corneal thickness influences the results of eye pressure testing.  If the cornea is excessively thick or thin, an adjustment to IOP’s must be made.  Pachymetry can also determine if a patient is a candidate for refractive surgery.

 

 

 

Step Twelve- Results

All the data is then presented and discussed with the patient. An assessment is then made as to eye health and the need for corrective eyewear, contact lenses, medications, etc. Patient is then given options and all questions are answered detailing future treatment and care.

 

*Every effort is made to respect your appointment time. If Dr. Hawkins is not on time you will be informed at your registration. Please try to arrive 10 minutes early on your appointment for paperwork. Also, please refrain from bringing children into the examination room and turn off your cell phone. Our exams last about an hour, and you will be dilated so please bring sunglasses or a driver if you have had problems with this procedure in the past. Your dilation will last about 3 hours.