It’s far more than just an eye test

It is rec­om­mend­ed that we all have an eye test at least once every two years. But research shows that 20 mil­lion peo­ple in the UK fail to do this annu­al­ly. And even more wor­ry­ing­ly, one in ten peo­ple admit to nev­er hav­ing had an eye exam­i­na­tion, ever, in their life­time.

Omar Has­san, head of pro­fes­sion­al ser­vices at Vision Express, comes up against this atti­tude all too often. “Eye sight is one of the most impor­tant sens­es we have. We acquire most of our infor­ma­tion about the world around us through visu­al cues. But most peo­ple take it for grant­ed and don’t go for reg­u­lar eye checks, par­tic­u­lar­ly peo­ple under the age of 30. Most peo­ple vis­it the den­tist far more often,” he says.

Neglecting problems

“It’s exac­er­bat­ed by the fact that we only know what we can see. Most peo­ple prob­a­bly don’t know what they’re miss­ing when their vision is dete­ri­o­rat­ing. I see peo­ple all the time who are squint­ing to read or bring­ing their phone right up to their face to be able to text, who insist their eye­sight is fine. Of course, it’s not, but they just don’t realise it. Their vision is already affect­ing them, but they’ve adapt­ed and adjust­ed to deal with it.

“There’s no need to strug­gle on though as these vision changes can be detect­ed and you can get glass­es or con­tact lens­es to help. You don’t have to put up with it.”

In addi­tion to detect­ing com­mon eye con­di­tions and changes in vision, an eye test can spot signs of more seri­ous under­ly­ing health prob­lems, includ­ing dia­betes, high blood pres­sure and eye can­cers

If you don’t know the extent of an eye test, or even if you do, it’s still easy to neglect our eyes. Prob­lems affect­ing the eye rarely hurt or cause prob­lems and changes in our eye­sight can be grad­ual or dis­missed as a nor­mal part of age­ing, says Mr Has­san.

“Our vision changes through­out life. The nor­mal phys­i­o­log­i­cal changes in our eyes are inevitable. But when that hap­pens is open for debate; some peo­ple say that our vision is already start­ing to decline by the time we reach 45,” he says.

“Just like a toothache can be a sig­nal to vis­it the den­tist, notic­ing changes in your eye­sight is a sign of a poten­tial eye con­di­tion that needs detect­ing through an eye test at a stan­dard high street opti­cian and cor­rec­tion by a qual­i­fied optometrist.”

Detecting illnesses

An eye test is a pow­er­ful weapon in the armoury to fight ill­ness and main­tain gen­er­al well­be­ing, as well as eye health. In addi­tion to detect­ing com­mon eye con­di­tions and changes in vision, giv­ing the oppor­tu­ni­ty to cor­rect any sight loss, an eye test can spot signs of more seri­ous under­ly­ing health prob­lems, includ­ing dia­betes, high blood pres­sure and eye can­cers.

An eye exam­i­na­tion at a high street opti­cians should include a test of visu­al acu­ity or read­ing let­ters of var­i­ous sizes from a chart. In addi­tion, there should be an assess­ment of your eye pow­er, near or far-sight­ed­ness, bal­anced eye­sight, a visu­al field check for “blind spots” and, if nec­es­sary, an optometrist can issue you with a pre­scrip­tion which can be used to pur­chase spec­ta­cles or in prepa­ra­tion for a con­tact lens tri­al.

But there’s more to a test than meets the eye. In the eye health assess­ment, an optometrist will con­duct a care­ful inspec­tion from the front to the back sur­face of the eyes, using an instru­ment called an oph­thal­mo­scope or Volk Lens. With this piece of equip­ment the optometrist can detect indi­ca­tors of con­di­tions, such as dia­betes or high blood pres­sure, by observ­ing changes to the fine blood ves­sels with­in the eyes. Oth­er com­mon eye con­di­tions, such as cataract and mac­u­lar degen­er­a­tion, can also be detect­ed.

A test of the pres­sure inside the eye can detect glau­co­ma, a con­di­tion which can affect sight, usu­al­ly due to a build-up of pres­sure with­in the eye.

Dur­ing a com­pre­hen­sive eye test an optometrist will usu­al­ly use an instru­ment called a tonome­ter to mea­sure the pres­sure inside your eyes, known as intraoc­u­lar pres­sure. A puff of air is direct­ed into the eye, mea­sur­ing intraoc­u­lar pres­sure based on the eye’s resis­tance to the air. It only takes a cou­ple of sec­onds to per­form, there’s no con­tact with the eye itself, and it can give valu­able infor­ma­tion about the health of your eye and any indi­ca­tors of more seri­ous eye con­di­tions. Caught ear­ly, these can be cor­rect­ed and treat­ed.

A fur­ther test avail­able at some high street opti­cians is called dig­i­tal reti­nal pho­tog­ra­phy, which uses a spe­cial cam­era to take a pho­to­graph of the inside of your eyes. The pic­ture is a detailed image of your fun­dus – the back of your eye – enabling you to see what the optometrist sees. As well as record­ing a per­ma­nent dig­i­tal pho­to­graph­ic ref­er­ence of your eye health for future com­par­i­son at sub­se­quent eye tests, this can reveal a lot about your eye­sight, your over­all well­be­ing and can even flag up under­ly­ing health con­di­tions.

In fact, there are more than 100 dif­fer­ent ways an optometrist can assess how your eyes are work­ing dur­ing an eye test, in addi­tion to ask­ing ques­tions about your gen­er­al health and lifestyle.

Early detection

Yet, despite all the tech­nol­o­gy and eye­care solu­tions avail­able, peo­ple can be sto­ical in per­se­ver­ing with their vision loss, which Mr Has­san says can make prob­lems even worse as ear­ly detec­tion can make treat­ment and man­age­ment eas­i­er.

“Our cus­tomers don’t tend to come in a day or two after notic­ing a prob­lem, but one or two years lat­er,” he says. “They have been strug­gling all that time, because vision changes are encroach­ing. Los­ing vision might be the first sign. When peo­ple start to notice is when it affects their dai­ly lives – dri­ving, read­ing, using the com­put­er at work and so on. The ear­li­er it’s iden­ti­fied the eas­i­er it is to resolve or man­age.”

Mr Has­san says every­one should exer­cise their right to an eye test; for many peo­ple, includ­ing peo­ple aged over 60, a test is free. It’s impor­tant to know what to expect and there are guide­lines laid down by the Col­lege of Optometrists which set out what should be includ­ed in an eye health assess­ment.

Every opti­cian should take a detailed his­to­ry, ask about any symp­toms you might be hav­ing, your med­ical and eye-relat­ed his­to­ry, and your dai­ly lifestyle. They should also mea­sure your vision and visu­al bal­ance, and look at the back of your eye to spot oth­er health prob­lems. An optometrist will be able to refer you to an oph­thal­mol­o­gist or a spe­cial­ist eye hos­pi­tal if they notice any abnor­mal­i­ties, such as glau­co­ma, cataracts, trau­ma to the eye or dry eye dis­ease.

If you’re one of the 10 per cent of peo­ple who has nev­er had an eye test, it’s still not too late to include it as part of a reg­u­lar, over­all health check. As Mr Has­san con­cludes: “The fun­da­men­tal thing is to remem­ber to go and see an opti­cian at least every two years.”

WHAT EYE TESTS CAN TELL YOU ABOUT YOUR WELLBEING

1. Hypertension and risk of stroke

A stroke is a brain attack which hap­pens when the blood sup­ply to the brain is restrict­ed. High blood pres­sure is one of the biggest risk fac­tors for stroke and con­tributes to more than half of all strokes in the UK. Dur­ing an eye test an optometrist looks at the small blood ves­sels in the back of your eye, to check for any dam­age caused by high blood pres­sure. Dr Dale Webb, direc­tor of research and infor­ma­tion at the Stroke Asso­ci­a­tion, says: “Any­one with con­cerns about their eye health should have a chat with their optometrist.”

2. Macular degeneration

Age-relat­ed mac­u­lar degen­er­a­tion (AMD) is the UK’s lead­ing cause of sight loss. It’s caused by dam­age to the mac­u­lar, part of the reti­na at the back of the eye that is dense­ly packed with light-detect­ing cells. High street opti­cians can check for AMD as part of an eye test. Some may use pho­tog­ra­phy or oth­er imag­ing to detect ear­ly signs. If diag­nosed, you may be referred to a hos­pi­tal to see an eye spe­cial­ist to con­firm the diag­no­sis, and receive sup­port and treat­ment.

3. Glaucoma

Look­ing at the back of the eye reveals whether or not your optic nerve is with­in nor­mal para­me­ters. Any sub­tle changes indica­tive of glau­co­ma can be mon­i­tored by an optometrist or referred to an oph­thal­mol­o­gist for treat­ment. There are a vari­ety of diag­nos­tic tools which can help spot whether or not you have glau­co­ma, even before any symp­toms devel­op. How­ev­er, not all tests are used dur­ing a high street eye test, so ask your optometrist which test is avail­able.

4. Alzheimer’s Disease

A sub­stan­tial body of evi­dence already sug­gests that changes to the tree-shaped pat­terns of veins and arter­ies in the eye can be linked to a num­ber of dis­eases, such as stroke and car­dio­vas­cu­lar dis­ease. Now researchers at the Uni­ver­si­ty of Dundee are lead­ing a £1.13-million project to help estab­lish if an eye test can be used to reveal the ear­ly stages of Alzheimer’s dis­ease. The three-year study is using spe­cial­ly devel­oped com­put­er soft­ware which analy­ses high-def­i­n­i­tion images of the eye to estab­lish whether such changes can act as an ear­ly indi­ca­tor of Alzheimer’s.

5. Eye cancer

There is no nation­al screen­ing pro­gramme in the UK for eye can­cer as these can­cers are not com­mon and there are no spe­cif­ic screen­ing tests. How­ev­er, can­cer­ous growths can occur inside the eye as in any oth­er part of the body. Can­cer Research UK says reg­u­lar eye tests can pro­vide the means to spot signs of eye can­cer ear­ly. By look­ing inside the eye, an optometrist is able to see any growth, and make an urgent refer­ral to a spe­cial­ist for fur­ther inves­ti­ga­tion and treat­ment. Ear­ly detec­tion can improve the chances of suc­cess­ful treat­ment.