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AFBAmerican Foundation®
for the Blind

Expanding possibilities for people with vision loss

Lesson 2: In the Eye Doctor's Office

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Picture of doctor using tonometer to measure pressure inside the eye

Routine eye examinations are an important part of maintaining the health of your eyes. How often you should see your eye doctor depends on your age, your general health, and whether you have any ongoing eye disorders. If you are age 60 or older, you should have an annual eye examination because cataracts and other age-related eye problems are more likely to develop as you get older. If you have health problems such as diabetes, yearly eye examinations are crucial for maintaining good eye health. If you have been diagnosed with an eye disease such as glaucoma, diabetic retinopathy, or macular degeneration, you need to see your ophthalmologist on an ongoing basis. This frequency should be determined by your eye doctor and may be more frequent than once a year.

Any kind of doctor's appointment can be stressful, but stress can be especially high if you aren't sure what the results of the exam will be or what will transpire during the appointment. The goal of this lesson is to better prepare and empower you for visits to your eye doctor.

Lesson Goals

  • Clarify the differences between normal vision, visual impairment, total blindness, legal blindness, and low vision;
  • Describe the similarities and differences among eye doctors—ophthalmologist, optometrist, and low vision specialist—and the services each provides;  
  • Prepare for a comprehensive dilated eye examination;
  • Prepare for a low vision examination;
  • Identify 25 frequently used abbreviations that commonly appear on eye doctor reports.

Click here to review the learning checks before reading the lesson.

Definitions of Terms Related to Visual Impairment

Normal Vision

Before discussing the definitions of terms that describe vision loss, it's necessary to define the term "normal vision." Vision is tested based on how accurately an individual can read lines of letters displayed on a chart 20 feet away. Each line of letters gets increasingly smaller. The standard chart used for this test is called the Snellen acuity eye chart. The Snellen chart tests distance acuity vision—how sharp your vision is when viewing something at a distance. A person whose central vision is clear and sharp enough to accurately read the eighth line of the chart from 20 feet is considered to have normal vision. Normal vision is expressed with the measurement of 20/20. As acuity decreases, the bottom number of this measurement gets larger, e.g.,  20/70, 20/200.

Visual Impairment

The term "visual impairment" describes the vision loss of someone who may not see well even with glasses or contact lenses, as well as of someone who is blind or unable to see at all. The term does not describe what a person can and cannot see but is instead part of a classification system. Below are some classifications of the term "visual impairment" from the World Health Organization (1992), based on the numbers used on the Snellen acuity eye chart:

  • Moderate visual impairment: 20/70 to 20/160
  • Severe visual impairment: 20/200 to 20/400 or visual field of 20 degrees or less
  • Profound visual impairment: 20/500 to 20/1000 or a visual field of 10 degrees or less
  • Light perception: the ability to know when a light is on or off in a room
  • Total blindness: the complete absence of light and form perception

Legal Blindness

The term "legal blindness" was defined by the American Medical Association (AMA) in 1934 in order to determine an individual's eligibility for government benefits. As such, it doesn't tell much about what a person can or cannot see. The definition has two parts. Part 1 is based on an individual's visual acuity. The clinical diagnosis refers to a central visual acuity of 20/200 or less in the better-seeing eye with best possible correction. In other words, if you can read only the large letter E on the first line of the Snellen eye chart at 20 feet while wearing your glasses or contact lenses, the eye doctor will record your acuity as 20/200 with best correction. Practically speaking, this means that you can see at 20 feet what someone with normal vision can see at 200 feet.

Part 2 of the AMA definition of legal blindness is based on the amount of peripheral vision an individual has. The clinical diagnosis refers to a visual field of 20 degrees or less without moving the eyes or head from side to side. This is frequently called tunnel vision. Someone with this level of peripheral vision can, when keeping his eyes and head still, see what someone with normal vision would see when looking through a regular drinking straw. Only one of these diagnoses is needed to meet the legal blindness criteria.

In 2007, the Social Security Administration updated the criteria for measuring legal blindness when using newer low vision test charts with lines that can measure visual acuity between 20/100 and 20/200. Under the new criteria, if a person's visual acuity is measured with one of the newer charts, and they cannot read any of the letters on the 20/100 line, they will qualify as legally blind, based on a visual acuity of 20/200 or less.

See the VisionAware Resources list at the end of the lesson for more information on low vision test charts.

Low Vision

The term "low vision" refers to any visual limitation that is not correctable by eyeglasses or medical or surgical treatment and that interferes with a person's daily activities, such as reading, cooking, housekeeping tasks, and walking outside safely without a mobility tool.

See the VisionAware Resources list at the end of the lesson for more information on legal blindness and low vision.

Functional Vision

How well an individual processes the visual information in his or her environment in order to go about daily tasks is called functional vision. Two people can have the same clinical diagnosis, such as glaucoma with 20 degrees of visual field and acuity of 20/100, but function very differently, especially if one has been trained to use his vision safely, efficiently, and effectively.

Eye Doctors and Their Services

There are three types of eye care—ophthalmology, optometry, and low vision—and three types of eye doctors—ophthalmologists, optometrists, and doctors who specialize in low vision. Although there are many similarities in the services provided by these doctors, there are differences that you will want to note based on your current and future needs.

Ophthalmology and Ophthalmologists

Ophthalmology is a branch of medicine that specializes in the anatomy, function, diseases and disorders of, and injuries to, the human eye. A practitioner in this field is called an ophthalmologist.

Ophthalmologists specialize in medical and surgical treatment of the eyes and prevention of eye disease. They are trained to provide the full spectrum of eye care from prescribing glasses and contact lenses to performing complex, delicate surgery. Ophthalmologists treat and prescribe medication to improve or prevent further complications from vision-related conditions. Many ophthalmologists are dedicated to scientific research into the causes, treatments, and cures for eye diseases and other health issues that affect vision. He or she must have completed four years of medical school, a one-year internship, and three years of residency training in ophthalmology. Ophthalmologists are licensed by state regulatory boards and will have the abbreviation M.D. (doctor of medicine) or D.O. (doctor of osteopathy) after their names. Ophthalmologists are required to fulfill continuing education requirements to stay current regarding the latest standards of practice.

Optometry and Optometrists

Optometry is concerned with the health and function of the eye and related structures. The specialist in this area of eye care is called an optometrist.

Optometrists conduct eye examinations, prescribe corrective contact lenses and glasses, and diagnose and treat eye diseases and disorders. Many states have passed legislation that permits optometrists to perform procedures such as laser treatments, administer local anesthesia and injections for macular degeneration, and prescribe a wider range of medications than is permitted in other states.

The optometrist must have a bachelor's degree before completing four years of optometric studies in optometry school. Optometrists often do further training in a specialization. The abbreviation O.D. (doctor of optometry) appears after their names. Optometrists are licensed by their state's regulatory board; each state determines the scope of optometric practice. Like ophthalmologists, optometrists are required to fulfill continuing education requirements to stay current regarding the latest standards of practice.

Low Vision Eye Doctor

Many optometrists and some ophthalmologists have an additional specialization in conducting low vision examinations. The specialization covers low vision testing, diagnosis, and treatment with optical and non-optical devices. If you still have some usable vision, a low vision examination can determine whether optical and non-optical devices and functional low vision training can help improve the efficient use of your functional vision.

Optician

An optician is an eye care professional trained to prepare and dispense optical devices, such as lenses and frames for eyeglasses, contact lenses, and artificial eyes (prosthetics). Some opticians also supply low vision optical devices. Opticians typically learn on the job under the training and supervision of an experienced optician. Their training is similar to an apprenticeship or internship where they learn how to interpret written prescriptions and technical instruction in measuring eyes and adjusting eyeglass frames under the education of the experienced optician.

A number of community colleges and technical schools offer an associate's degree in opticianry. Other colleges offer a one-year certificate. As of December 2016, 23 states require licensure for opticians.

See the VisionAware Resources list at the end of the lesson for more information on the different types of eye care professionals.

The Comprehensive Dilated Eye Examination

The comprehensive dilated eye examination is performed by an ophthalmologist or optometrist, although some non-medical parts may be handled by a vision technician. This exam takes from 30 minutes to an hour to complete.

To prepare for your appointment, you will want to be ready to answer questions doctors commonly ask during comprehensive dilated eye exams and to have a list of your own questions to ask about your exam results.

Components of the Comprehensive Dilated Eye Exam

This examination should always include the following components.

Health and Medication History

  • Your overall health and that of your immediate family
  • List of all prescriptions and over-the-counter medications and vitamin supplements
  • Questions about high blood pressure, diabetes, and other risk factors

Vision History

  • How well you can see at present, including any recent changes in your vision
  • Eye diseases you or family members have had
  • Previous eye treatments, surgeries, or injuries
  • Date of your last eye examination

Current Vision Problems

  • How long you've been having any current vision problems
  • When the problems occur

Tests

The comprehensive dilated eye exam assesses all parts of your eyes and their current health and function.

  • External eye examination: the doctor will examine your sclera, conjunctiva, eyelids, eyelashes, and tear ducts to make sure they are healthy.
  • Internal eye examination: your doctor will use a machine with special lenses and use drops to enlarge (dilate) your pupil, making it easier to see your retina and optic nerve. Expect the drops to cause excessive tears, blurred vision, and sensitivity to light, especially sunlight. Be sure to bring dark sunglasses to wear after the appointment.
  • Tonometry test: this test measures the pressure in your eyes to see if you are susceptible to glaucoma.
  • Acuity test (refraction): a refraction helps the doctor determine the sharpness and clarity of both your near reading and distance vision, and helps determine if your vision can be improved or corrected with glasses or contact lenses.
  • Visual field test: this examination helps determine how much peripheral (side) vision you have and how much surrounding area you can see.

Examination Results

Based on the tests, the doctor can tell if the visual problems you are experiencing are normal age-related changes or symptoms of disease and if further testing, a referral to another specialist, or treatments are needed.

Here are some suggestions for what you may want to ask your doctor once he or she has performed the exam:

  • What is the name of my eye disease or disorder?
  • What is the cause of my vision loss?
  • Is my condition stable, or can I lose more sight?
  • Is there any treatment for my eye condition?
  • What is my visual acuity?
  • Do I have a loss of side (or peripheral) vision?
  • Will regular eyeglasses help me?
  • How can I protect my remaining vision?
  • Do I need any special medications?
  • Do I qualify as legally blind? If so, what does legally blind actually mean?
  • Am I entitled to any special services or benefits?
  • What resources and rehabilitation services are available to me?

See the VisionAware Resources list at the end of the lesson for more information on the comprehensive dilated eye exam.

The Low Vision Examination

Few people with vision loss are totally blind. In fact, 85 percent of all people with visual impairments have some usable vision. It's very probable that you are one of those people. Therefore, it's extremely important that you have a comprehensive functional low vision examination performed by a doctor with a specialization in low vision. At the conclusion of the exam, the low vision doctor may provide you with referrals to one or more certified specialists, including a low vision therapist (CLVT or SCLV) (designation for occupational therapists who are certified in low vision), a vision rehabilitation therapist (CVRT), and an orientation and mobility specialist (COMS) to provide the practical training. The low vision therapist (CLVT) is not a low vision eye doctor, but someone with training to help you learn to use your vision better. The CLVT and SCLV often work for an ophthalmologist, optometrist, or doctor with specialization in low vision. (SCLV’s can be reimbursed by Medicare for a certain number of training hours as authorized by a doctor.)

The low vision examination probably will take longer than the comprehensive dilated eye examination you usually have with your regular ophthalmologist or optometrist. Although it may include a few of the same tests, the low vision examination will focus on tests to determine the following:

  • How much usable vision you have;
  • How well you currently use your vision;  
  • What kinds of practical, everyday skills and non-optical and optical devices can help you use your vision more effectively?

Components of the Comprehensive Low Vision Examination

Low Vision History

  • When your vision problems began
  • Activities that are becoming difficult for you
  • The vision rehabilitation services you are using

Acuity Test (Low Vision Refraction)

  • The low vision doctor may use the Snellen chart but will also use special eye charts that present different-sized letters and numbers to help determine your near and distance vision more accurately.These tests may be conducted at closer distances than the Snellen chart.
  • The Amsler grid test: this test uses a chart with dark horizontal and vertical lines that form a grid. If you see wavy, distorted, missing, or broken lines, you may be experiencing eye problems that need monitoring. Ask the doctor for a copy of this test to put on your refrigerator or other convenient location so you can monitor your vision daily.

See the VisionAware Resources list at the end of the lesson for more information on the low vision examination.

Specialized Tests

Your doctor will test your depth perception, color vision, contrast sensitivity, and light sensitivity.

Questions the Low Vision Doctor May Ask

You will be asked a wide range of questions. Some of these questions will be about your habits or activities in reading and near vision activities, such as the following:

  • Can you read regular print?
  • How many words per minute can you read?
  • How long can you read before your eyes tire?
  • Is reading so tedious you have difficulty remembering what you've read?
  • Can you travel independently without getting disoriented? Be prepared to explain.
  • Does sunlight bother you? If so, in what way?
  • Bring sunglasses you are currently using.

All of this information can help guide discussions with the low vision doctor and the doctor's professional staff.

See the VisionAware Resources list at the end of the lesson for more information on questions to ask your eye care specialist.

Additional Tips to Prepare for the Low Vision Examination

Your needs as a person with low vision are unique to you, and the best solutions for you are those tailored to your individual needs, priorities, and extent of remaining vision. The more specific you can be about the types of things you want to be able to read, the more your doctor can help you.

  • Bring a list of everything you want to be able to see and a packet of the kinds of items and papers you want to be able to read. Examples of items you might bring include: materials such as bills, bank statements, official papers, and cards in your wallet; handwritten letters; books, magazines, cookbooks, and other printed items.
  • Make a list of specific activities you have difficulty doing due to your vision. Examples may include: reading labels on medications, canned goods, cleaning products, etc.; using a computer; watching TV; playing cards and other games; sewing; crafts; shopping; and attending the theater or sports events. Be prepared to talk about your goals and expectations for each.
  • Bring any glasses, adaptive aids, and magnifiers you are currently using or have stashed in a drawer. Be prepared to describe what you like and dislike about each.
  • If you are diabetic, be sure to bring a snack in case the exam lasts longer than expected.
  • Bring all forms of insurance with you. Keep in mind, many devices or aids will not be covered by your insurance plan. If you have questions about whether the exam will be covered by your insurance, you should ask the low vision clinic prior to your appointment.

See the VisionAware Resources list at the end of the lesson for more information on preparing for your visit to your eye care specialist.

Abbreviations Used on Eye Reports

Every profession has its list of related abbreviations. Eye doctors have more than a hundred they use when taking notes and writing their reports. Below is a list of 25 that may help you better understand what the doctor is talking about in the examination report.

Types of Testing

AC:  accommodation (changes in the ocular lens from distant to near vision)

PERRLA: pupils equal round reactive to light and accommodation (do your pupils react normally)

IOP: intraocular pressure (tonometry test for glaucoma)

LVA: low vision aid (variety of magnifiers)

Terminology Associated with Acuity Testing

BV: binocular vision (seeing with both eyes together)

NV: near vision (reading test)

DV: distance vision (seeing across the office or further)

OD: right eye

OS: left eye

OU: both eyes

VA: visual acuity

VF: visual field (peripheral vision)

CF: count fingers (one test when acuity can't be measured)

HM: hand motion (similar to count fingers)

LP light: perception (able to see lights but no reading)

NLP: no light perception

Terminology Related to Diseases and Age-Related Disorders of the Eyes

DR: diabetic retinopathy

VH: vitreal hemorrhage

RD: retinal detachment

PVD: posterior vitreous detachment

DES: dry eye syndrome

MH: macular hole

POG: primary open angle glaucoma

AMD: age-related macular degeneration

Cat: cataract

Suggestions to Empower You

  • Ask someone you trust to go with you who can help listen and take notes.
  • Be aware that the doctor may speak to your escort and not to you. Before the appointment, remind your escort not to answer any questions and to direct the doctor back to you.
  • Let the doctor know you want to make an audio recording of the appointment. You may receive an overwhelming amount of new information and hear unfamiliar terminology during your appointment. Recording the appointment gives you the option of listening and digesting the information in your own time.
  • Be assertive. At the conclusion of the appointment, ask when you will be contacted with the test results. Call the doctor's office if you do not hear by the expected date.
  • Contact the low vision office the day before an appointment to make certain any lab tests or information from other doctors have been sent.
  • Educate yourself about your eye condition. Build your knowledge base so you can ask your doctors good questions. Ask the doctor to explain the test results to you in terms you can understand, so you can discuss the implications of your eye condition.
  • Ask for assistance in getting around the doctor's office or locating the restroom. The staff may not realize you do not see well enough to safely move through the halls of the clinic independently.
  • Practice good human guide techniques. To be safe, ask to hold onto the elbow of anyone guiding you. Don’t allow anyone to pull or push you.

Summary

Even if your eye exam results are disappointing or scary, remember that you are the same person that walked into that appointment. With training, tools, and resources from an orientation and mobility specialist, vision rehabilitation therapist, and low vision therapist, you can continue to live a productive, fulfilling, independent life!


Learning Checks

Which of the following is not an accurate statement about the terms "normal vision" or "normal visual acuity"?

  1. Normal visual acuity is expressed by the numbers 20/20.
  2. Normal vision is measured by the clarity of vision at a distance of 20 feet.
  3. Someone who can accurately read line eight on the Snellen eye chart meets the criterion for having normal visual acuity.
  4. Normal visual acuity can be expressed by the numbers 10/20.

Answer: d

Which of the following is not an accurate statement about the term "visual impairment"?

  1. The term "visual impairment" refers to people who have been diagnosed at least as legally blind.
  2. The term "visual impairment" describes the vision loss of someone who may not see well even with glasses or contact lenses.
  3. The term "visual impairment" describes the vision loss of someone who is blind or is unable to see anything.
  4. The term "visual impairment" describes someone whose vision loss interferes with daily activities, such as reading, cooking, housekeeping tasks, and walking outside safely without a mobility tool.

Answer: a

Which of the following is not an accurate statement about the term "legal blindness"?

  1. Part 1 refers to a central visual acuity of 20/200 or less in the better-seeing eye with best possible correction.
  2. Part 2 refers to a visual field of 20 degrees or less and is commonly called tunnel vision.
  3. An individual with normal visual acuity and 20 degrees of visual field is not considered legally blind.
  4. Only a diagnosis of Part 1 or Part 2 is necessary to meet the criteria for legal blindness.

Answer: c

Which of the following statements about the three types of eye doctors discussed in this lesson are accurate?

  1. Ophthalmologists are medical doctors trained to provide the full spectrum of eye care, from prescribing corrective lenses to performing complex surgical procedures, as well as to perform scientific research into the causes, treatments, and cures of eye diseases.
  2. Optometrists conduct eye examinations, prescribe corrective contact lenses and glasses, and frequently specialize in low vision services. Because they are not medical doctors, they do not perform surgery, but in some states they are authorized to diagnose and treat eye diseases and disorders.
  3. A low vision doctor is an optometrist or ophthalmologist who has an additional specialization in conducting a wider spectrum of low vision tests to determine a more accurate diagnosis, and to suggest treatment with optical and non-optical devices.
  4. Ophthalmologists, optometrists, and low vision doctors must have several years of advanced education in eye anatomy, diseases, and treatment; must be licensed by state regulatory boards; and must maintain continuing education requirements to stay current regarding the latest standards of practice.

Answer: all of the above

Which of the following tests are more representative of a low vision examination?

  1. Tests for depth perception, color vision, contrast sensitivity, and light sensitivity
  2. Assessment of all external and internal parts of your eyes and their current health and function
  3. Near and distance vision tests with optical and non-optical devices
  4. Acuity and field tests

Answer: a and c

Click here to return to the beginning of the lesson.


VisionAware Resources

The following links will take you to VisionAware online resources that support this lesson. Please be advised that information in these links may go beyond the scope of this lesson or this course.

Information on Low Vision

Specialized Low Vision Eye Charts

Low Vision and Legal Blindness Terms and Descriptions

The Different Types of Eye Care Professionals

The Comprehensive Dilated Eye Examination

The Low Vision Examination

Questions to Ask Your Eye Care Specialist

Preparing for the Visit to Your Eye Care Specialist


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