The comprehensive routine exam is to evaluate your eye health and to determine an eyeglasses prescription. The contact lens evaluation, or fitting, is a separate exam to determine your prescription for contact lenses and the suitability of the contact lens fit. Contact lenses are medical devices that are in direct contact with your eyes. This requires a more careful evaluation to make sure the lenses fit properly, your vision is clear and that the lenses are comfortable to wear.
For a new contact lens wearer, there will be training to help you master the process of putting in and taking out the lenses. We will not dispense lenses to patients unless they can demonstrate the ability to insert and remove lenses safely. In addition, a patient will have a period of time to wear the lenses to assure clear vision and comfort. Proper lens hygiene protocol to keep the lenses clean and eyes healthy will be explained as well.
For patients who have worn contacts before, it is important to review the proper care of lenses, perform an exam to make sure your prescription is accurate and your eyes are healthy.
There are many different contact lens brands and many different kinds of lenses to consider. Some contact lenses are changed daily and then disposed of, while others may be worn daily and disposed after two weeks or a month. Once we determine the best lens for your prescription and lifestyle, we can quote a cost for a supply of lenses. To save money some patients may choose to purchase a limited supply, to last either three or six months. Others prefer a year’s supply, knowing they are happy with the product. The cost for an annual supply is often less than purchasing individual boxes. Contact our office for updated contact lens pricing.
We are happy to help you order your contact lens supply if your contact lens prescription is current. Our prices are competitive with most online options. You can call us and order by phone. We can take payment by phone or on our website. Contact lens orders will be verified by our office for accuracy and shipped directly to your home. We also have a new feature on our website that allows you to order online directly. Orders made on our website will be checked for completeness and accuracy and shipped to your home. Currently shipping is free.
Hard contact lenses, also called rigid gas permeable (RGP) lenses are definitely an option for many patients. RGP lenses are made from materials that provide excellent oxygen transmissibility to the cornea, provide greater visual clarity than soft lenses and cost less to wear because they are not disposable and do not have to be replaced unless they are lost or several years old. RGP lenses are slightly more challenging to fit than soft lenses and are initially less comfortable than soft lenses. However, once they are adapted to, they are just as comfortable as soft lenses are. They are particularly suited to very high spherical prescriptions, prescriptions with high amounts of astigmatism and corneas with keratoconus. Initial fitting fees and the cost of lenses are more expensive than soft lenses, but after the patient has adapted and is routinely wearing the lenses, the costs associated with RGPs are less than with soft lenses.
No. You do not need a referral to get a routine eye exam. Certain medical insurance plans may require a referral from your primary care physician to see an eye specialist or to obtain additional testing. Claims may be denied if the appropriate referral is not obtained. Contact your medical insurance company for more information.
An optometrist is a health professional who went to optometry school for four years after college for a specialized education in eye disease, optics, contact lens and glasses prescriptions. Optometrists excel at primary eye care with particular emphasis on eyeglass and contact lens prescriptions. Optometrists can prescribe medications for many eye conditions and will refer patients to the appropriate specialist for advanced testing and surgery. Ophthalmologists are medical doctors who complete four years of medical school followed by a two or three year program of study in eye disease often specializing in specific eye pathology such as corneal and retinal disease. Many are also trained as surgeons performing retinal surgery, cataract surgery, LASIK surgery and other advanced eye care treatments.
Dilation is a part of the exam where drops are instilled in the eye to cause the pupils to dilate, or open up very wide. This gives the doctor a much better view of the peripheral retina to detect any pathology. A dilated eye exam is important every few years to make sure there are no sight threatening retinal changes such as tears, tumors or bleeding . It is particularly important for diabetics to have their eyes dilated annually, as diabetes is a leading cause of bleeding in the retina which may lead to blindness. Patients with ongoing diabetic retinopathy or other retinal pathology may need to have their eyes dilated several times per year to monitor any progression.
A regular eye exam involves no procedures or tests that should cause any eye pain. Some patients are sensitive to bright lights which may cause some discomfort during brief parts of the examination. Extreme sensitivity to bright lights should be evaluated by your doctor.
A refraction is that part of the eye exam that involves looking through many different lenses so that an optimal prescription can be determined for glasses or contact lenses. The refraction tells the doctor what your best visual acuity is and what lens prescription is needed to achieve it. It also provides the prescription that is the starting point for a contact lens fitting and evaluation. For routine eye exams with vision plans, the refraction is bundled together with the health evaluation part of the examination and billed together as one charge. When using medical insurance the refraction is considered a separate procedure and not part of the regular exam. It is almost never covered by medical insurance and is billed to the patient as an additional charge.
The air puff test, or non contact tonometry, is a quick and painless way to determine the pressure of the fluid inside your eye. A modern non contact tonometer will give a very small, almost imperceptible puff. Determining the pressure inside your eye is an important indicator of eye health and an important factor in determining if you have glaucoma. If you have a strong dislike to the air puff test, your eye pressure can still be measured with an applanation tonometer. This involves using a single eye drop to each eye and gently measuring your eye pressure with a Goldmann applanation probe. The procedure is very accurate and completely painless.
A careful eye exam on a healthy patient should take about 30 minutes. If there is a significant medical history, ocular pathology, or a difficult refraction, the exam may take longer. An eye exam involves determining your visual acuity with and without glasses correction, determining your optimal glasses prescription and assessing the health of your eye by examining your eyes with a binocular microscope, checking your intraocular pressures and carefully looking at your retinas.
Eye exams for children are usually done at age five when they begin school. Children’s eyes can be examined at any age if there is any suspicion of eye disease or poor vision. While very young patients cannot answer questions, there is much that can be seen and measured in the eye doctor’s office. A objective refraction can be performed on very young children with very accurate results. Eyes can be measured and monitored for any eye turns, also known as strabismus. Amblyopia, or “lazy eye”, in young children should be addressed early so we have the best chance of achieving normal visual acuity as the child grows older.
Children’s eyes should also be evaluated for early signs of myopia or nearsightedness. New research is showing that early intervention using one or more myopia control therapies can significantly reduce the risk of myopia progression.
A routine eye examination is a good idea even if you see fine. An eyeglass prescription may be needed to avoid eye strain, tiredness or headaches. You may have small changes to your vision that may not be apparent, but over the course of several years these small changes lead to significant changes in your prescription that may make your new glasses very difficult to adapt to. Many medical problems that are often undiagnosed may be apparent in the course of an eye exam. These conditions may be sight threatening or even life threatening.
For an individual in good health with no vision problems an eye exam every two or three years should be fine. Young children should have an eye exam every year as young eyes change and glasses prescriptions should be monitored for best vision. Young children should also be evaluated for early signs of myopia. New research is showing that early intervention may prevent myopic progression in children. Individuals with diabetes or other significant medical problems should have their eyes examined annually. Patients with medical eye conditions may need to have their eyes evaluated several times per year. If you’re a contact lens wearer having your eyes checked once a year is a very important way to make sure your eyes are healthy and not being compromised by contact lens over wear. Patients don’t often realize that contact lens wear can affect the thickness and clarity of the cornea and can also irritate the palpebral conjunctiva under the lids that come in contact with your contact lenses. An annual eye exam will catch these problems and suggest changes before they become more serious issues.
We have a very large selection of frames that suit the needs of most of our patients. We have many designer brand choices but also sell frames from smaller independent distributors. We also have a large selection of specialty children’s frames including Miraflex and Tomato frames. All frames we sell are warrantied for any manufacturer’s defects for one year from the date of dispensing. We feel as confident in these products as in the more familiar name brands. We also sell frames that are suitably priced for patients who do not have vision insurance and need to pay for glasses out of pocket. If you have a frame you’ve purchased elsewhere and would like your prescription in the frame, we’d be happy to provide prescription lenses for your frame. Please call and let us know what you need.
We do not compete with the least expensive online retailers because we offer what they can’t – personal service and professional expertise.
When we complete your eyeglasses, we are happy to ship them to you, or you can return to our office to pick them up and make sure they are a great fit!
A favorite frame can be reused for new and updated lenses. You should consider the condition of the frame and if it makes sense to put new, possibly expensive lenses, into a frame that doesn’t have much life left in it. However, if the frame looks good, we can certainly put new lenses into it. Bring your frame in and let us take a look. We have cut new lenses in many patient’s own frames, in our own lab, and we would be happy to examine your frame and give it a second chance.
Eyeglasses cause light from things we see to come to a focus on the retina. This creates clear vision. Just like focusing a camera lens makes a distant object appear sharp on a film plane. Eyeglasses will not change the anatomy or the physiology of your eyes. If glasses are worn, things you see will be clearer. If not worn, they will be blurrier. Glasses will not cause any damage to your eyes. If one puts on glasses that have the wrong prescription, vision may be blurry, your eyes may feel strained and tired and you may even suffer from mild headaches. However, no permanent, negative consequences will ensue. Often, when patients wear glasses and get used to seeing clearly, they perceive increased blurry vision when the glasses are removed, giving the impression that the glasses made their vision worse.
Sometimes a favorite pair of glasses can be repaired. We offer many eyeglass repair services to fix your broken glasses including readjustments, screw replacement, nosepad replacement. Send us a photo of your glasses, or bring them to our office and we’ll let you know if we can repair them.
Fees and Insurance
We pride ourselves on a high standard of vision and eye care for our patients. Due to vision plan floccinaucinihilipilification of eye exams performed by optometrists, we are not able to accept most discount vision plans.
We are out of network providers for most vision plans. We will provide all documentation and invoices so patients can submit claims for reimbursement to any vision plan they are a member of.
We accept most medical insurance plans including Traditional Medicare. We do not participate with any Medicare Advantage plans, sometimes called “Part C” . The refraction portion of the exam (determining your lens prescription) is not covered by most medical insurance plans, so you will be charged for the refraction. You will also be charged your copay and any portion of your medical insurance deductible that has not been met. Following claim submission, any overcharged fees will be refunded to the patient.
If you do not have insurance that we participate with, you should not feel that an exam is not available to you. Our self pay fees for eye exams are very affordable and should not stand as a barrier to obtaining a quality eye health evaluation and eyeglass prescription. There are many busy optometric practices across the country that do not participate with any vision insurance or medical insurance plans for eye care. If your plan is one with which we do not participate, we will provide documentation needed to utilize your benefits on an out-of-network basis. If you have any questions about your insurance and our fee schedule, please call our office for more details.
A copay is a portion of the exam fee, determined by a patient’s insurance coverage, as the patient’s responsibility and must be paid before the exam begins. Though a patient may pay a percentage of their salary for health benefits, this fee is required by the insurance company to be paid by the patient to the doctor, before any other benefits will be paid out. By law copays cannot be waived.
A deductible is the amount that a patient must pay to a provider before benefits will be paid by the insurance company. Once the deductible has been met a patient no longer has any out of pocket medical expenses. For example, If someone has a medical plan with a $500 deductible, the patient must pay the first $500 in charges before the insurance company will pay out the rest of the benefit.
Myopia progression is best predicted by age, with younger onset associated with faster advancement and, eventually, higher levels of myopia. Myopia control alternatives should be explained to parents of any myopic child, but especially those under the age of 12. Myopia mitigation should be prioritized for children presenting with the following risk factors: parental myopia, reduced time outdoors, East Asian ethnicity, less than age expected hyperopia and female gender.
Unfortunately, there is insufficient evidence that any myopia control treatments will be effective in slowing cases of pathologic myopia. Pathologic or degenerative myopia is defined as the presence of structural changes due to axial elongation in eyes with high myopia. Fortunately, most children develop what’s often known as “school age” myopia, which is generally well-managed with current myopia control treatments.
The average age at which myopia usually stops progressing is 15 to 16 years. About 10% of myopes will progress beyond the age of 21 years. Researchers are beginning to evaluate over five years of data from a few new studies, and have come to expect some lessening of myopia control efficacy over time. But, cumulatively, children will still gain benefit from myopia control treatment over traditional single-vision spectacle correction for as long as their myopia continues to progress. Stopping treatment may be considered when the myopia progression rate slows, which is usually when children reaches late adolescence. However, close monitoring is mandatory in managing these patients. If myopia progression is detected, restarting treatment is advisable. Parents should be educated about the costs and benefits of continued treatment and assisted to make an informed decision via the use of cycloplegic autorefraction and axial length measurements to monitor progression.
There is clear evidence from randomized clinical trials that increased outdoor time can delay the onset of myopia, and thus decrease the final amount of myopia a child develops. Increased outdoor time may also have a small protective effect in slowing myopia progression. Greater duration of near work and close working distances have been associated with increased risk of myopia. A recent observational study provides some suggestions that a closer working distance may also be associated with increased progression. Other possible risk factors include use of LED lamps for homework, dim light, fewer hours of sleep and living in an urban environment.
The same factors that are related to onset are likely related to progression, but further research is needed to fully understand the interplay of genetic and environmental factors in both onset and progression. For now, the potential benefit and very low cost and risk associated with outdoor time and breaks from close near work make them ideal goals for pre-myopic and myopic children. This means limiting cell phone and tablet use as much as possible.
Recent evidence, together with changes found during COVID-19 lockdowns demonstrates that behavior changes related to digital devices may indeed worsen myopia in youngsters. Although more high-quality research is needed to prove causation, optometrists caring for children at risk should evaluate the possibility that excessive smart device use could lead to an increase in myopia. The recent global growth in myopia prevalence predates the advent of digital devices. However, this result does not rule out the likelihood that such devices would have an impact on future myopia trends.
2019 brought FDA approval of the first contact lens specifically developed to slow the progression of nearsightedness, CooperVision’s MiSight lens. With an excellent efficacy and safety profile, this daily disposable lens is a great choice for any child within the available parameters.
The foundation of evidence-based care is to provide patients with all of the appropriate options for which they are a candidate and to assist them in making an informed decision in their care. There is much evidence to demonstrate that other soft multifocal contact lenses, orthokeratology, and atropine can also slow myopia progression. Recent studies have also demonstrated that executive bifocals (lenses with a line across the entire lens) can have a smaller, but still clinically meaningful, effect in slowing progression. There are many appropriate reasons why patients may prefer to start with one treatment over another. These include cost, patient compliance, current prescription and any binocular vision anomalies.
Preventive measures such as increased outdoor programs and activities and changes on limiting near distance activities in preschool children should be implemented. These are cost effective and relatively easy to administer.
CooperVision has released findings from a two-year clinical study for its Diffusion Optics Technology, which is aimed to help children reduce the progression of myopia. According to a recent press release, children who wore their Diffusion Optics Technology-enabled spectacles full time for two years, including not removing them for near vision activities, progressed one-half diopter less than those who wore the control spectacles—a drop of 59 percent. Beginning this month, CooperVision will make the new product available to eyecare providers in the Netherlands. This technology is currently unavailable in the United States.
MiSight is a center-distance design with a +2.00 D add. If there are concerns with cost, or the need for astigmatic correction, the CooperVision Biofinity spherical and toric multifocals with a center-distance design and a +2.00 or +2.50 add would be good evidence based off-label options. NaturalVue multifocal contact lenses are another good choice with center distance design and a wide range of available parameters. There are intriguing hypotheses about how to modify the central treatment or mid-peripheral zones, but no solid evidence that any of the different orthokeratology designs offer superior myopia control efficacy. Thus, any orthokeratology lens design can be used for myopia control. Recent data on executive bifocals demonstrated good efficacy with a +1.50 add, but a higher add (e.g., +2.50) would also be a valid evidence-based treatment.
A recent trial showed that 0.05% atropine was the most effective in controlling both axial length and refractive error progression, and should be the starting point for drug treatment.
While multiple studies are underway to explore the combination of drug and device treatments, we still lack sufficient evidence about when to add another treatment or when to switch treatments. Unfortunately, there is no way to determine which treatment will be most effective for which children. Online calculators may overestimate the myopia control effect, but current work aims to develop standard “ocular growth curves” that may help better determine whether a treatment is effective.
Until then, the best treatment plan includes regular monitoring of cycloplegic autorefraction and axial length, and discussions about general expectations for progression (i.e., 0.50 to 1.00 D/year). Due to expected seasonal variations in progression, it’s not recommended to change treatments before at least a year, unless there are issues with intolerance or noncompliance.
Some of the most challenging patients are those with higher myopia, astigmatism, or binocular vision issues, as these are overlooked areas of research. Parents of young children with high myopia should be counselled about potential genetic causes. If parents still elect treatment, doctors should carefully educate and document lowered expectations for efficacy.
Children with more than 1.00 D of astigmatism may not have sufficient acuity with the MiSight lens and may be better served with a soft toric multifocal. Generally, orthokeratology is more successful with less than 1.75 D of with-the-rule astigmatism, and when the astigmatism is not greater than the myopia. Bifocal glasses and atropine are options for nearly any refractive error. Children can become more exophoric with multifocal or orthokeratology lenses. Children who are exophoric or demonstrate signs of convergence insufficiency should be questioned as to any symptoms and treated for their binocular vision disorder prior to initiating myopia control since treatments may exacerbate underlying conditions.