After the your pupils are dilated, its time to take a close look at the eyes lens and then examine the health of the back portion of the eye. I take another look at the lens in the eye after the pupil is dilated due to the fact that the lens sits directly behind the pupil. I am unable to see the outer aspect of the lens until the pupil is dilated. It is this portion of the lens that many cataracts start at and are first visible.
The image below is from Wikipedia and is a good cross section of the human eye:
The picture below shows a cataract, notice how cloudy the lens is.
After a careful examination of the lens, I next look at the optic nerve and macula (labeled as the “Fovea Centralis” in the ocular cross section above) utilizing a biomicrocsope and a lens to focus on the back portion of the eye. I look at the shape, size and contour as well as the color of the optic nerve. In a patient with Glaucoma, the optic nerve will have a larger indentation on its surface and may look a bit pale in color. I look for any change in the optic nerve between exams as this can be an indication of the development of Glaucoma. The picture below shows a healthy optic nerve as well as the arteries and veins that enter and leave the eye with the optic nerve.
This is an image of an optic nerve in a Glaucoma patient. The arrows point out the edges of the depression on the optic nerve that is referred to as the “optic cup”. This optic cup is enlarged and quite deep, due to damage from Glaucoma.
The next image is a 3D Reconstruction of a patient’s optic nerve. This image shows the size and depth of their optic cup, information that is very useful when evaluating the health of the optic nerve.
Once I’ve evaluated the optic nerve, I then evaluate the Macula. The Macula is the area in the retina where all of our detailed vision occurs. The Macula has a typical appearance and structure. I evaluate the structure with the Retinal Thickness Analyzer. The photo below shows a healthy Macula.
The next image is a Retinal Thickness Analysis of a normal Macula. Each color represents a different thickness in the Macula. Thickening or thinning of the macula are usually indicative of one or more eye diseases. Using this technology allows me to detect many conditions earlier in the disease process, allowing me to take preventative or corrective action sooner.
Once the health and structure of the optic nerve and macula have been evaluated, I then look at the rest of the structures in the back section of the eye. I utilize a Binocular Indirect Ophthalmoscope and a lens. This combination allows me to evaluate the structures that are located further away from the optic nerve and macula.
Summing It All Up
Once the ocular health evaluation is completed, its finally time to “sum it all up” for you, the patient. Taking your previous vision and vision correction devices as well as your current prescription into account, I will inform you of all of your vision correction options, which may include; glasses, contact lenses, Vision Shaping Treatment, refractive surgery or a combination of several options. I will also make recommendations about eyeglass lens materials, designs and treatments that will maximize your vision and enjoyment of your new eye wear.
I’ve started using an iPad to show and share information that we’ve gathered during the course of your examination. Images of your corneal endothelium, your Retinal Thickness Analysis and other data are easy to share this way, and I’ve found that patients are able to understand the information, what it means and how it impacts their eye health, vision correction and ocular health.
If I have detected any ocular diseases, I will either recommend further testing to better understand the condition, or any treatment that is indicated. If necessary, we will discuss a referral to a surgeon if your condition warrants surgical care. Fortunately, this doesn’t happen too often, but its not rare either.
That’s it, you’ve just completed your eye exam at Warren Eye Care. From start to finish, we strive to keep our patients comfortable, informed and involved in their eye examination and their eye care.