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Diagnostics in ophthalmology requires high accuracy and good equipment. For a general examination of the eyeball, you need a microscope with a special illuminator - slit lamp, and for fundus examination - several types ophthalmoscopes(direct, reverse).
Determination of visual acuity (visometry) is carried out using projection equipment and a set of trial lenses or a phoropter. To determine a patient’s nearsightedness, farsightedness and astigmatism, a device is needed autorefkeratometer, which automatically focuses on the retina, determines the refraction, the optical power of the cornea and prints the result. To determine intraocular pressure, several methods are usually used: non-contact pneumotonometer, Maklakov tonometer and Goldmann applanation tonometer or tonograph.
Computer perimetry allows you to determine the boundaries of the field of vision in patients. Ultrasound research methods(A-method, B-scan) allow you to measure the size of the eyeball and its internal structures, study the acoustic transparency of the vitreous body and the position of the membranes of the eyeball. Keratotopograph and pachymeter give an idea of the refractive power, topography of the corneal surface and its thickness. All these devices are available at the Ophthalmological Center of the SM-Clinic holding. But we are also equipped with equipment that few clinics can afford: an optical coherence tomograph, a fundus camera, an optical non-contact biometer, a digital slit lamp.
The parameters of the eyeball are measured in diopters, millimeters and microns, and pressure in millimeters of mercury. The most thorough examinations are carried out before eye surgeries, since an error in measuring the optical axis of the eye of 1 mm corresponds to 3 diopters in glasses. And an error in measuring intraocular pressure can lead to serious damage to the optic nerve during dynamic monitoring of glaucoma.
Diagnosis of eye diseases is carried out according to certain generally accepted schemes, but may also include the use of additional equipment. Patients with cataracts undergo a slit-lamp examination, visual acuity, intraocular pressure, corneal power, and ultrasound examinations. In patients with glaucoma, in addition, intraocular pressure is measured using several methods and the boundaries of the visual field are checked. For patients with refractive diseases (myopia, farsightedness, astigmatism), refraction is measured not only with a narrow, but also with a wide pupil.
allows for ultra-fine diagnostics of the condition of the optic nerve and diseases of the central zone of the retina. allows you to show the patient the condition of his fundus, as well as discuss the features of vascular changes with related specialists - cardiologists, neurologists, endocrinologists. The digital photo-slit lamp allows the patient to be shown a picture of the anterior part of the eye before and after surgical treatment. A non-contact optical biometer measures the parameters of the eyeball and automatically calculates artificial lenses for a given refractive result. Each disease requires an individual approach and the use of special equipment, just as each patient needs special care and attention.
Prices for diagnostic services of an ophthalmologist "SM-Clinic" (Moscow)
| Name of service |
Price, rub.)* |
| Standard ophthalmological examination (autorefractometry, visometry, pneumotonometry, biomicroscopy of the anterior part of the eye, biomicroscopy of the fundus with a narrow pupil, total perimetry, consultation with an ophthalmologist) | 3 470 |
| Extended ophthalmological examination (autorefractometry, visometry, tonometry, computer perimetry and/or contact (non-contact) biometry, fundus ophthalmoscopy in conditions of mydriasis (in the absence of contraindications), consultation with | 4 830 |
| Optical coherence tomography of the optic nerve (1 eye) | 1 790 |
| Examination of the fundus using a Fundus camera (1 eye) | 1 790 |
| Fluorescein angiography of the fundus (1 eye) | 3 470 |
| Examination of the fundus with an ophthalmochromoscope (color) | 840 |
| Study of visual acuity with correction with a spherical lens | 740 |
| Binocular vision study | 320 |
| Pachymetry / Computer perimetry | 630 / 1050 |
| Ophthalmometry / Computer ophthalmotonometry | 370 / 580 |
| Ophthalmoscopy with aspheric lens (1 eye) | 370 |
Regular examination is the best prevention of eye diseases. Diagnosis of such diseases can only be carried out by an experienced ophthalmologist in a specialized equipped office. It is important that the ophthalmologist identifies the first signs of abnormalities in time. Successful treatment largely depends on the speed of their detection at the stage of reversible changes.
One examination by a doctor and a subsequent conversation with him is not enough. It is necessary to carry out additional specific examination methods using modern equipment to clarify the diagnosis and prescribe treatment. The doctor should tell you in detail about the exact diagnosis and determination of visual acuity, as well as possible deviations and pathologies.
Ultra-modern diagnostic methods help establish a highly accurate diagnosis and allow highly effective control of treatment. Here are the most common methods for diagnosing the most common eye diseases.
A doctor's examination reveals abnormalities using the following painless procedures:
A procedure that allows the ophthalmologist to see parts of the fundus on the surface of the eye. This method remains one of the most significant and popular in diagnosing eye diseases. The non-contact method is performed using a lens or a special ophthalmoscope device.
Allows you to evaluate the main function - distance visual acuity - during preventive examinations. Decreased vision is an important signal in diagnosing diseases. The examination is first carried out without correction - the patient, closing one eye at a time, names the letters on the table indicated by the ophthalmologist. If there are violations, the procedure is performed with correction using specialized frames and lenses.
This method determines the optical power of the eye and diagnoses refractive errors and vision defects: myopia, farsightedness, astigmatism. Now the procedure has begun to be carried out using refractometers, which allows the patient not to waste a lot of time and facilitates the eye doctor’s manipulations.
The study is recommended for people over 40 years of age, as they have an increased risk of developing glaucoma. The procedure measures intraocular pressure, which is carried out in the following ways: by palpation, according to Maklakov (using weights) with a pneumotonometer and others.
An important method for determining the presence of peripheral vision and diagnosing pathological diseases - glaucoma and the process of destruction of the optic nerve. The study is carried out using specialized hemispherical electrical devices on which light spots are displayed.
Vision test for color perception
Widespread and intended to determine violations of color sensitivity thresholds - color blindness. The inspection is carried out using Rabkin's polychromatic tables.
The procedure for microscopic examination of the ocular segment using a special device - a slit lamp. With significant magnification, the ophthalmologist can clearly see the tissues of the eye - the cornea and conjunctiva, as well as the lens, iris, and vitreous body.
Determines the degree of astigmatism of the anterior surface and the refractive power of the cornea. The radius of refraction is measured with an ophthalmometer.
Grishberg's simple method allows you to determine the angle of strabismus using an ophthalmoscope through which the patient is looking. The ophthalmologist determines the problem by observing the reflection of light on the corneal surface.
It is carried out in case of obstruction of the lacrimal canaliculi. Thin tubes (cannulas) with a syringe and solution are inserted into the lacrimal ducts. If the patency is normal, then the liquid from the syringe will penetrate into the nasopharynx. If there is an obstruction, the solution will not pass through and will spill out.
It is usually performed in infants and elderly people for therapeutic purposes, since they may experience stenosis of the lacrimal openings. Bougienage is carried out using expanding probes using local anesthesia.
To determine the diagnosis of common ailments, such as conjunctivitis, myopia, cataracts, such diagnostic methods are usually sufficient. However, if the eye doctor doubts the diagnosis, then additional methods of examining diseases using specialized equipment carried out in optometric centers are possible.Additional methods in eye diagnostics
Ultrasound is a popular research tool due to the receipt of accurate and complete information and the high effectiveness of the procedure. Ultrasound examination is necessary to detect eye abnormalities, tumors, and retinal detachment.
The method determines the central field of vision for colors and is used to detect diseases of the optic nerve, glaucoma and retina. The diagnostic kampimeter consists of a special large screen, where the patient looks with each eye alternately through a slit on a black screen.
The electrophysiological research method has found wide application in the study of the cerebral cortex, retina and levels of damage to the optic nerve, and the function of the nervous department of the optical apparatus.
A method that studies the surface of the cornea before laser correction. It is carried out on an automated computer system by scanning to determine the sphericity of the surface.
Dynamic study of intraocular pressure. IOP takes about 5 minutes; in such a short period of time, you can obtain important information about the state of fluid outflow inside the eye.
The method allows you to accurately determine the thickness of the cornea; it is necessarily prescribed for laser operations
Shows the condition of the fundus and retinal vessels. A series of high-precision images are taken after the fluorescent solution is administered intravenously.
The non-contact modern OCT method is used to determine the condition of the optic nerve and retina.
Operational examination under an optical device to detect ticks.
A procedure that determines tear production. The test is performed for symptoms of dry eye. An ophthalmological test is placed on the edge of the patient's lower eyelid, which can be used to determine if it is wet with tears.
A method for accurately detecting glaucoma using a lens. The angle of the anterior chamber is examined.
It is used for retinal dystrophy and detachment, as well as to obtain data on its peripheral parts that were not detected during a classical examination.
High-precision modern instruments and a variety of techniques allow us to accurately and effectively conduct research on the visual organs at the cellular level. Most diagnostics are carried out non-contact and painlessly, without requiring prior preparation of the patient. In the relevant sections you can learn in detail about the methods for diagnosing eye diseases.
Ophthalmology includes hundreds of eye diseases. The most common methods for diagnosing the most common human eye diseases are described here.
Ophthalmologists pay special attention to identifying early signs of eye diseases. The importance of early diagnosis of pathological changes in the eyes can hardly be overestimated, since success in the treatment of eye diseases largely depends on the timing of its detection, namely, detection at the stage of reversible changes.
Diagnosis of eye diseases is carried out by an ophthalmologist in a specially equipped ophthalmology office.
There are serious eye diseases that have a significant impact on vision. These are cataracts, glaucoma, retinal detachment, and a number of inflammatory and infectious diseases. Early diagnosis and treatment of these diseases is the main way to prevent partial loss of vision and sometimes blindness.
Modern ophthalmology allows you to perform all the necessary studies to make an accurate diagnosis, including the following studies:
- determination of visual acuity (computer and subjective methods);
- examination and determination of the condition of the anterior segment of the eyeball;
- measurement of intraocular pressure;
- fundus examination;
- computer keratotopography (examination of the cornea for accurate diagnosis of astigatism and keratoconus);
- fluorescein digital angiography - computer images of the fundus and examination of retinal vessels for selective treatment of areas of retinal damage (diabetic retinopathy, macular degeneration, etc.);
- complex of electrophysiological studies;
- complex of laboratory tests for preoperative preparation.
Special means for diagnosing eye diseases include: computed tomography of the eye, computer perimetry, ultrasound examination of the eye, topography of the fundus, tonography, determination of color vision, gonioscopy, skiascopy.
Modern diagnostic tools in ophthalmology contribute not only to making an accurate diagnosis, but also allow monitoring and effectively managing the process of treating diseases.
Methods of eye examination in ophthalmology
A comprehensive examination by an ophthalmologist includes the following procedures:
Visometry- This is a measurement of distance visual acuity. In this case, the patient looks at a table with letters, numbers or other signs and names the objects that the ophthalmologist points to. Determination of visual acuity is carried out first without correction, then, if there are violations, with correction (using a special frame and lenses). Decreased vision is an important symptom in the diagnosis of eye diseases.
Tonometry- This is a measurement of intraocular pressure. It can be carried out in several ways (using a pneumotonometer, weights (according to Maklakov), palpation, etc.). This procedure is mandatory for people over 40 years old, because... It is after 40 years that the risk of developing glaucoma increases significantly, which is what this study is aimed at identifying.
Refractometry- this is a determination of the optical power of the eye (refraction). The procedure is currently carried out using automatic refractometers, which greatly facilitates the work of the ophthalmologist and saves the patient’s time. Using this method, refractive errors are diagnosed: myopia, farsightedness and astigmatism.
Color vision testing- this is a method of examining the eyes, carried out using special tables (Rabkin tables) and serves to determine such color vision disorders as protanopia, deuteranopia or color weakness (types of color blindness).
Perimetry is the definition of a person's peripheral vision. The procedure is carried out using special devices, which are a hemisphere, on the inner surface of which light signals are projected. This is an important method for diagnosing eye diseases such as glaucoma, partial optic atrophy, etc.
Biomicroscopy is a method of examining the anterior segment of the eye using a slit lamp (special microscope). Using biomicroscopy, an ophthalmologist can see at high magnification such eye tissues as the conjunctiva, cornea, as well as deeper structures - the iris, lens, vitreous body.
Ophthalmoscopy- this is a study that allows the doctor to see the fundus (inner surface of the eye) - this is the retina, blood vessels. This is one of the most common and important methods in diagnosing eye diseases. The procedure is carried out contactlessly, using a special device - an ophthalmoscope or lens.
Where to get an eye examination
Despite the large number of ophthalmological centers, not all of them have all the necessary equipment and specialists capable of working on it and correctly interpreting the results. One of the few institutions that has the most modern equipment and world-class specialists is the Moscow Eye Clinic. Along with this, affordable prices and impeccable service make this eye clinic one of the best in Russia.
Ophthalmometry- this is a determination of the refractive power of the cornea in different meridians. In this way, the degree of corneal astigmatism can be determined. The study is carried out using a special device - an ophthalmometer.
Determination of the angle of strabismus- this is a fairly simple procedure, an example is the Grishberg method - the patient looks through an ophthalmoscope, and the doctor monitors the reflection of light on his cornea and, depending on this, determines the angle of strabismus.
Probing (bougienage) of the lacrimal canals is a procedure performed for therapeutic purposes, most often in infants, but also in older people, who often experience narrowing of the lacrimal openings. It is performed under local anesthesia using special dilating probes.
Washing the tear ducts- this procedure is carried out for diagnostic purposes if there is a suspicion of obstruction of the lacrimal ducts. It can also be used for medicinal purposes. Special cannulas are inserted into the lacrimal openings on the eyelid, to which a syringe with a solution is attached. If the lacrimal ducts are blocked, the liquid from the syringe enters the nasal cavity, but if there is obstruction of the lacrimal ducts, the liquid pours out or does not pass at all.
As a rule, these methods are quite sufficient to diagnose the most common eye diseases (for example, myopia, conjunctivitis, cataracts, etc.). However, if an ophthalmologist has doubts about the diagnosis, he can use additional methods for diagnosing eye diseases, which require special equipment and are carried out in specialized ophthalmological centers or departments.
Special methods used in the diagnosis of eye diseases
Campimetry- this is the determination of the central field of vision, often in terms of colors. The device for this study is called a campimeter and is a special 2x2 meter screen on which markers are presented to the patient (alternately with the right and left eyes). This method can be used to diagnose eye diseases such as glaucoma, diseases of the retina and optic nerve.
Ultrasound examination of the eyeball (ultrasound)- This is a fairly common research method that has gained popularity due to its efficiency, lack of complications and information content. This study is used to diagnose eye diseases such as retinal detachment, neoplasms of the eye and orbit, and foreign bodies.
Electrophysiological study (EPS)- this allows you to assess the condition of the retina, optic nerve, and cerebral cortex. Those. functions of the entire nervous tissue of the visual apparatus. This method has found wide application in the diagnosis of diseases of the retina and optic nerve.
Tonography is a recording of intraocular pressure (IOP) over time. The procedure takes about 4-5 minutes, but during this time important information about outflow can be obtained.
Keratotopogram is a study showing the surface of the cornea, its “topographic map”. The study is carried out before laser operations on the cornea, if keratoconus and keratoglobus are suspected.
Pachymetry- This is a determination of the thickness of the cornea. This study is mandatory for laser operations.
Fluorescein angiography- this is one of the methods that shows the condition of the retinal vessels. The study is carried out by intravenous administration of a contrast agent and taking a series of images in the retinal vessels.
Examination of eyelashes for demodex- this procedure involves collecting eyelashes followed by examination under a microscope. Depending on the number of mites found, the disease “demodicosis” is diagnosed.
OTC (optical coherence tomography) is optical coherence tomography. Used to assess the condition of the retina and optic nerve. Used in eye examinations for diseases such as retinal dystrophy and detachment, glaucoma, and optic nerve diseases.
Gonioscopy is a procedure in which an ophthalmologist examines the angle of the anterior chamber using a special lens. The study is carried out during examination for glaucoma.
Schirmer test- This is a study that allows you to determine tear production. A special paper strip is placed behind the patient’s lower eyelid, after which it is determined how saturated it is with tears. This test is performed for a disease such as dry eye syndrome.
Fundus examination with Goldmann lens is a method used to evaluate the peripheral parts of the retina that are not visible during normal fundus examination. It is used to diagnose eye diseases such as retinal detachment and dystrophy.
Vision diagnostics- this is an important step in the prevention of eye diseases and maintaining good vision for many years! Timely detection of ophthalmological pathology is the key to successful treatment of many eye diseases. As our practice shows, the occurrence of eye diseases is possible at any age, so everyone needs to undergo a high-quality ophthalmological examination at least once a year.
Why is a complete vision diagnostic necessary?
Vision diagnostics is necessary not only to identify primary ophthalmological pathology, but also to resolve the issue of the possibility and advisability of performing a particular operation, choosing patient treatment tactics, as well as accurately diagnosing the condition of the organ of vision in a dynamic aspect. In our clinic, a complete ophthalmological examination is carried out using the most modern diagnostic equipment.
What tests are included in a complete diagnostic examination of the visual system and what are they?
Any ophthalmological examination begins, first of all, with a conversation, identifying the patient’s complaints and collecting an anamnesis. And only after this they move on to hardware methods for studying the organ of vision. The hardware diagnostic examination includes determining visual acuity, studying the patient’s refraction, measuring intraocular pressure, examining the eye under a microscope (biomicroscopy), pachymetry (measuring the thickness of the cornea), echobiometry (determining the length of the eye), ultrasound examination of the eye (B-scan), computer keratotopography and careful (of the fundus) with a wide pupil, determining the level of tear production, assessing the patient’s field of vision. When ophthalmological pathology is detected, the scope of the examination is expanded to specifically study the clinical manifestations in a particular patient. Our clinic is equipped with modern, highly professional ophthalmological equipment from companies such as ALCON, Bausch & Lomb, NIDEK, Zeiss, Rodenstock, Oculus, which allows us to conduct studies of any level of complexity.
In our clinic, special tables with pictures, letters or other signs are used to determine the patient’s visual acuity and refraction. Using an automatic phoropter NIDEK RT-2100 (Japan), the doctor, alternately changing the diopter glasses, selects the most optimal lenses that provide the best vision for the patient. In our clinic, we use NIDEK SCP - 670 halogen sign projectors with 26 test patterns and analyze the results obtained under narrow and wide pupil conditions. Computer refraction research is carried out on a NIDEK ARK-710A autorefractive meter (Japan), which allows you to most accurately determine the refraction of the eye and the biometric parameters of the cornea.
Intraocular pressure is measured using a non-contact tonometer NIDEK NT-2000. If necessary, measurement of intraocular pressure is carried out by contact method - Maklakov or Goldman tonometers.
To examine the condition of the anterior segment of the eye (eyelids, eyelashes, conjunctiva, cornea, iris, lens, etc.), a NIDEK SL-1800 slit lamp (biomicroscope) is used. On it, the doctor evaluates the condition of the cornea, as well as deeper structures such as the lens and vitreous body.
All patients undergoing a complete ophthalmological examination are required to undergo an examination of the fundus, including areas of its extreme periphery, under conditions of maximum pupil dilation. This makes it possible to identify dystrophic changes in the retina, diagnose its tears and subclinical detachments - a pathology that is not clinically determined by the patient, but requires mandatory treatment. To dilate the pupils (mydriasis), fast and short-acting drugs are used (Midrum, Midriacil, Cyclomed). If changes are detected in the retina, we prescribe preventive laser coagulation using a special laser. Our clinic uses the best and most modern models: YAG laser, NIDEK DC-3000 diode laser.
One of the important methods for diagnosing a patient’s vision before any refractive surgery for vision correction is computer topography of the cornea, aimed at examining the surface of the cornea and its pachymetry - measuring its thickness.
One of the anatomical manifestations of refractive error (myopia,) is a change in the length of the eye. This is one of the most important indicators, which in our clinic is determined using a non-contact method using the IOL MASTER device from ZEISS (Germany). This is a combined biometric device, the research results of which are also important for calculating IOLs for cataracts. Using this device, during one session, the length of the eye axis, the radius of curvature of the cornea and the depth of the anterior chamber of the eye are measured immediately one after another. All measurements are carried out using a non-contact method, which is extremely comfortable for the patient. Based on the measured values, the built-in computer can suggest optimal intraocular lenses. The basis for this is the current international calculation formulas.
Ultrasound examination is an important addition to generally accepted clinical methods of ophthalmological diagnostics; it is a widely known and informative instrumental method. This study makes it possible to obtain information about the topography and structure of normal and pathological changes in the tissues of the eye and orbit. Using the A-method (one-dimensional imaging system), the thickness of the cornea, the depth of the anterior chamber, the thickness of the lens and inner membranes of the eye, as well as the length of the eye are measured. The B-method (two-dimensional imaging system) allows you to assess the condition of the vitreous body, diagnose and evaluate the height and extent of choroid and retinal detachment, identify and determine the size and localization of ocular and retrobulbar neoplasms, as well as detect and determine the location of a foreign body in the eye.
Another necessary method for diagnosing vision is visual field testing. The purpose of determining the field of view (perimetry) is:
- diagnosis of eye diseases, in particular glaucoma
- dynamic observation to prevent the development of eye diseases.
Also, using hardware techniques, it is possible to measure the contrast and threshold sensitivity of the retina. These studies provide the possibility of early diagnosis and treatment of a number of eye diseases.
In addition, other parametric and functional data of the patient are examined, for example, determining the level of tear production. The most diagnostically sensitive functional studies are used - the Schirmer test, the Norn test.
Another modern method for studying the inner lining of the eye is optical scanning tomography of the retina. This unique technique allows you to get an idea of the structure of the retina throughout its entire depth, and even measure the thickness of its individual layers. With its help, it became possible to detect the earliest and smallest changes in the structure of the retina and optic nerve, which are not accessible to the resolving abilities of the human eye. The operating principle of an optical tomograph is based on the phenomenon of light interference, which means that the patient is not exposed to any harmful radiation during the examination. The examination takes a few minutes, does not cause visual fatigue and does not require direct contact of the device’s sensor with the eye. Similar devices for vision diagnostics are available only in large clinics in Russia, Western Europe and the USA. The study provides valuable diagnostic information about the structure of the retina in macular degeneration, diabetic macular edema and allows us to accurately formulate a diagnosis in complex cases, as well as obtain a unique opportunity to monitor the dynamics of treatment based not on the subjective impression of the doctor, but on clearly defined digital values of retinal thickness. In glaucoma, the study provides comprehensive information about the condition of the optic nerve and the thickness of the layer of nerve fibers around it. High-precision measurement of the latter parameter guarantees the identification of the earliest signs of this terrible disease, even before the patient notices the first symptoms. Considering the ease of implementation and the absence of unpleasant sensations during the examination, we recommend repeating control examinations on the scanner for glaucoma every 2-3 months, for diseases of the central zone of the retina - every 5-6 months. Repeated examination allows you to determine the activity of the pathology, clarify the correctness of the chosen treatment, and also correctly inform the patient about the prognosis of the disease, which is especially important for patients suffering from macular holes, since the likelihood of a similar process developing in a healthy eye can be predicted after a tomograph study. Early, “preclinical” diagnosis of fundus changes in diabetes mellitus is also possible with this amazing device.
What happens after hardware research is completed?
After completing hardware tests (vision diagnostics), the doctor carefully analyzes and interprets all the information received about the condition of the patient’s organ of vision and, based on the data obtained, makes a diagnosis, on the basis of which a treatment plan for the patient is drawn up. All research results and treatment plan are explained to the patient in detail.
What is the cost of a diagnostic test?
The cost of a diagnostic examination (vision diagnostics) depends on its volume. For the convenience of patients, we have created complexes in accordance with common eye diseases, such as cataracts, glaucoma, myopia, farsightedness, and fundus pathology.
More detailed information about the cost of this service can be found in the section
Thank you
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
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What happens at an appointment with an ophthalmologist?
During the examination of the patient ophthalmologist assesses the condition of various structures of the eyeball and eyelids, and also checks visual acuity and other parameters that give him information about the functioning of the visual analyzer. Where does the ophthalmologist see?
Visit an ophthalmologist ( ophthalmologist ) can be done at the clinic ( in the ophthalmologist's office) or in a hospital where the doctor sees in a specialized ophthalmology department. In both cases, the doctor will be able to conduct a full examination of the person’s visual system and make a diagnosis. At the same time, in a hospital setting, more modern equipment may be available, which allows, in doubtful cases, to conduct a more complete diagnosis. Moreover, if, when examining a patient in a hospital, the doctor identifies a disease or injury that requires urgent surgical intervention ( for example, with retinal detachment), he can hospitalize the patient and perform the necessary operation within the shortest possible period of time, thereby reducing the risk of complications and vision loss.Examination by an ophthalmologist
As mentioned earlier, when examining a patient, an ophthalmologist examines the condition and functioning of various structures of the visual analyzer. If during a standard examination the doctor discovers any abnormalities, he may conduct additional tests.An examination by an ophthalmologist includes:
- Checking visual acuity. Allows you to evaluate the ability of the eye to clearly see two different points located at a certain distance from each other. Primary impairment of visual acuity can occur with myopia, farsightedness, astigmatism and other pathologies.
- Study of the refractive structures of the eye. Allows you to determine the functional state of the refractive system of the eye, that is, the ability of the cornea and lens to focus the image directly on the retina.
- Visual field examination. Allows you to examine peripheral vision, which may be impaired due to glaucoma and other pathologies.
- Fundus examination. Allows you to study the vessels of the fundus and the retina, damage to which may cause decreased visual acuity, narrowing of the visual fields and other defects of the visual analyzer.
- Measuring intraocular pressure. It is the main test in the diagnosis of glaucoma.
- Checking color perception. Allows you to determine whether a person can distinguish different colors from each other. This function of the visual analyzer may be impaired in some people suffering from color blindness.
Ophthalmologist's chart for checking visual acuity
The first thing an ophthalmologist checks when examining a patient is visual acuity. As mentioned earlier, this term refers to the ability of the human eye to distinguish between two points located at a certain distance from each other. To conduct the study, the doctor uses special tables on which rows with letters or figures are printed ( for examining the deaf and dumb, children, etc.) of various sizes.The essence of the study is as follows. The patient sits on a chair located at a distance of 5 meters from a well-lit table mounted on the wall. The doctor gives the patient a special flap and asks him to cover one eye with it, but not to close it completely ( that is, do not close your eyelids). The patient should look at the table with his other eye. Next, the doctor begins to point to the letters in various rows of the table ( first to larger ones, then to smaller ones), and the patient must name them. The result is considered satisfactory when the patient easily ( without squinting) will be able to read letters from 10 ( above) table row. In this case, we are talking about one hundred percent vision, which the ophthalmologist records in the patient’s chart. Next, he asks to cover the other eye with a shutter and repeats the procedure in the same way.
When examining young children ( who can't read yet) tables with images of animals, plants and other objects are used. At the same time, for the examination of deaf and mute patients, instead of letters, the tables depict circles with a cutout on one side ( right, left, top or bottom). During the examination, the patient must indicate to the doctor which side the notch is located on.
An ophthalmologist's device for examining the fundus of the eye
The fundus of the eye is the posterior inner surface of the eyeball. The procedure for examining the fundus itself is called ophthalmoscopy, and the device used to perform it is called an ophthalmoscope.The essence of the procedure is as follows. The bright lights in the room are turned off, and the patient sits on a chair opposite the doctor. The doctor brings an ophthalmoscope to the patient's eye ( a device consisting of a light source and a magnifying lens) and directs light through the pupil into the eye being examined. Light rays hit the fundus of the eye and are reflected from it, as a result of which the doctor, through a magnifying glass, can observe various structures in this area - the retina, fundus vessels, optic nerve head ( the place in the fundus of the eye where nerve fibers of photosensitive cells leave the eyeball and travel to the brain).
Fundus examination helps in diagnosing:
- Glaucoma. Characteristic of this pathology is the so-called excavation of the optic nerve head, which is “squeezed out” as a result of increased pressure inside the eyeball.
- Retinal angiopathy. During ophthalmoscopy, the doctor identifies modified, irregularly shaped and sized blood vessels in the fundus.
- Retinal detachments. Under normal conditions, the retina is attached to the wall of the eyeball very weakly, supported mainly by intraocular pressure. For various pathological conditions ( for eye injuries, wounds) the retina can become detached from the wall of the eye, which can lead to deterioration or complete loss of vision. During ophthalmoscopy, the doctor can determine the location and severity of the detachment, which will allow planning further treatment tactics.
What does an ophthalmologist put in your eyes to dilate your pupils?
As stated earlier, during an ophthalmoscopy, the doctor shines a beam of light into the patient's eye through the pupil and then examines the fundus of the eye using a magnifying glass. However, under normal conditions, light entering the retina causes a reflex constriction of the pupil. This physiological reaction is designed to protect photosensitive nerve cells from damage from too much bright light. However, during the examination, this reaction may prevent the doctor from examining parts of the retina located on the lateral parts of the eyeball. It is to eliminate this effect that before the examination, the ophthalmologist instills drops into the patient’s eyes, which dilate the pupil and fix it in this position for a certain time, allowing a full examination of the fundus of the eye.It is worth noting that these drugs cannot be used if you have glaucoma, since pupil dilation can lead to blockage of the outflow tract of intraocular fluid and provoke an increase in intraocular pressure. The doctor must also inform the patient that for a certain time after the procedure the patient may experience pain or burning in the eyes when exposed to bright light, and will also not be able to read books or work at the computer. The fact is that the drugs used to dilate the pupil also temporarily paralyze the ciliary muscle, which is responsible for changing the shape of the lens when viewing closely spaced objects. As a result of this, the lens is flattened as much as possible and fixed in this position, that is, a person will not be able to focus vision on a nearby object until the effect of the drug wears off.
Ophthalmologist instruments for measuring IOP
IOP ( intraocular pressure) is a relatively constant value and normally ranges from 9 to 20 millimeters of mercury. Marked increase in IOP ( for example, with glaucoma) can lead to irreversible changes in the retina. That is why the measurement of this indicator is one of the important diagnostic measures in ophthalmology.To measure IOP, the ophthalmologist uses a special tonometer - a cylindrical weight weighing 10 grams. The essence of the study is as follows. After instilling a local anesthetic solution into the patient's eyes ( a drug that temporarily “turns off” the sensitivity of the eyes, as a result of which they will not respond to the touch of foreign objects to the cornea) the patient lies down on the couch face up, directing his gaze strictly vertically and fixing it on some point. Next, the doctor tells the patient not to blink, after which he places the surface of the cylinder on his cornea ( tonometer), which was previously coated with special paint. Upon contact with wet ( moisturized) the surface of the cornea washes off some of the paint from the tonometer. After a few seconds, the doctor removes the cylinder from the patient’s eye and presses its surface onto special paper, on which a characteristic imprint in the form of a circle remains. At the end of the study, the doctor uses a ruler to measure the diameter of the resulting circle-imprint, based on which he establishes the exact intraocular pressure.
Checking color perception ( pictures of an ophthalmologist for drivers)
The purpose of this study is to determine whether the patient is able to distinguish colors from each other. This function of the visual analyzer is especially important for drivers who constantly need to navigate the colors of traffic lights on the road. For example, if a person cannot distinguish the color red from green, he may be prohibited from driving a vehicle.To check color perception, the ophthalmologist uses special tables. Each of them depicts numerous circles of various sizes, colors ( mostly green and red) and shades, but similar in brightness. Using these circles, a certain image is “masked” in the picture ( number or letter), and a person with normal vision can easily see it. At the same time, for a person who does not distinguish colors, recognizing and naming an “encrypted” letter will be an impossible task.
How else does an ophthalmologist check vision?
In addition to the standard procedures described above, the ophthalmologist has other studies in his arsenal that allow a more accurate assessment of the condition and functions of various structures of the eye.If necessary, the ophthalmologist may prescribe:
- Biomicroscopy of the eye. The essence of this study is that, using a special slit lamp, a narrow strip of light is directed into the patient’s eye, illuminating the cornea, lens and other transparent structures of the eyeball. This method allows you to identify various deformations and damage to the structures under study with high accuracy.
- Study of corneal sensitivity. To assess this parameter, ophthalmologists usually use a thin hair or several threads from a bandage, which they touch the cornea of the eye being examined ( first in the center and then along the edges). This makes it possible to identify a decrease in the sensitivity of the organ, which can be observed in various pathological processes.
- Study of binocular vision. Binocular vision is the ability of a person to clearly see a specific image with both eyes at the same time, ignoring the fact that each eye is looking at an object from a slightly different angle. To test binocular vision, ophthalmologists use several methods, the simplest of which is the so-called Sokolov experiment. To carry out this experiment, you should take a sheet of paper, roll it into a tube and bring it to one eye ( both eyes must remain open during the entire examination). Next, you need to place your open palm on the side of the paper tube ( its edge should be in contact with the tube). If the patient has normal binocular vision, when the hand is raised to the paper, the effect of the so-called “hole in the palm” will appear, through which what is visible through the paper tube will be visible.
What tests can an ophthalmologist prescribe?
Laboratory diagnosis is not the main diagnostic method in ophthalmology. However, when preparing for eye surgery, as well as when identifying certain infectious pathologies, the doctor may prescribe certain tests to the patient.An ophthalmologist may prescribe:
- General blood analysis– to determine the cellular composition of the blood and identify signs of infection in the body.
- Microscopic studies– to identify microorganisms that cause infectious and inflammatory damage to the eye, eyelids or other tissues.
- Microbiological examination– to identify and identify the causative agent of an eye infection, as well as to determine the sensitivity of the infectious agent to various antibiotics.
- Biochemical blood test– to determine glucose levels ( Sahara) in the blood if diabetic retinal angiopathy is suspected.
Selection of glasses and lenses from an ophthalmologist
The main and most accessible methods for correcting diseases of the refractive system of the eye is the use of glasses or contact lenses ( which are installed directly on the outer surface of the cornea). The advantages of spectacle correction include ease of use and low cost, while contact lenses provide more precise vision correction and are also less noticeable to others, which is important from a cosmetic point of view.Using glasses or contact lenses you can correct:
- Myopia ( myopia). As mentioned earlier, with this pathology, light rays passing through the cornea and lens are refracted too strongly, as a result of which they are focused in front of the retina. To correct this disease, the doctor selects a diverging lens, which “shifts” the focal length somewhat posteriorly, that is, directly to the retina, as a result of which a person begins to clearly see distant objects.
- Hypermetropia ( farsightedness). With this pathology, light rays are focused behind the retina. To correct the defect, the ophthalmologist selects a converging lens that shifts the focal length anteriorly, thereby eliminating the existing defect.
- Astigmatism. With this pathology, the surface of the cornea or lens has an uneven shape, as a result of which light rays passing through them hit different areas in front of and behind the retina. To correct the defect, special lenses are made that correct existing irregularities in the refractive structures of the eye and ensure that the rays are focused directly on the retina.
Does an ophthalmologist prescribe computer glasses?
When working at a computer for a long time, the load on the eyes increases significantly, which is caused not only by overstrain of the accommodation apparatus, but also by the radiation from the monitor to the retina of the eye. To eliminate the impact of this negative effect, the ophthalmologist may recommend that patients whose activities involve working at a computer use special safety glasses. The lenses of such glasses do not have any refractive power, but they are covered with a special protective film. This eliminates the negative impact of glare ( bright dots) from the monitor and also reduces the amount of light entering the eyes without affecting image quality. As a result, the load on the organ of vision is significantly reduced, which helps prevent ( or slow down) the development of symptoms such as visual fatigue, lacrimation, redness of the eyes, and so on.Medical examination and certificate from an ophthalmologist
A consultation with an ophthalmologist is a mandatory part of the medical examination that workers of many professions must undergo ( drivers, pilots, doctors, police officers, teachers and so on). During a routine medical examination ( which is usually performed once a year) the ophthalmologist evaluates the patient's visual acuity, and ( if necessary) conducts other studies - measures visual fields and intraocular pressure ( if glaucoma is suspected), examines the fundus ( if the patient has diabetes or high blood pressure) and so on.It is also worth noting that a certificate from an ophthalmologist may be needed in some other circumstances ( for example, to obtain a permit to carry a firearm, to obtain a driver's license, etc.). In this case, an examination by an ophthalmologist does not differ from that during a regular medical examination ( the doctor evaluates visual acuity, visual fields and other parameters). If during the examination the specialist does not identify any abnormalities in the patient’s organ of vision, he will issue an appropriate conclusion ( certificate). If the patient is diagnosed with a decrease in visual acuity, a narrowing of the visual fields, or any other deviation, the doctor may prescribe appropriate treatment for him, but in the conclusion he will indicate that this person is not recommended to engage in activities that require one hundred percent vision.
Are ophthalmologist services paid or free?
All insured ( having a compulsory health insurance policy) residents of Russia have the right to free consultations with an ophthalmologist, as well as free diagnostic and treatment measures. To receive the listed services, they need to contact their family doctor and explain the essence of their vision problem, after which the doctor ( if necessary) will issue a referral to an ophthalmologist.It is worth noting that free ophthalmologist services under the compulsory medical insurance policy ( compulsory health insurance) are found only in state medical institutions ( clinics and hospitals). All ophthalmologist consultations and visual analyzer examinations performed in private medical centers are paid.
When is a follow-up appointment with an ophthalmologist indicated?
Dispensary registration is a special form of monitoring a patient, in which the doctor conducts a full diagnosis and prescribes treatment for the patient’s chronic disease of the visual analyzer, and then regularly ( at certain intervals) examines him. During such an examination, the doctor assesses the state of vision and monitors the effectiveness of the treatment, and, if necessary, makes certain changes to the treatment regimen. Also, an important task of dispensary registration of patients with chronic eye diseases is the timely identification and elimination of possible complications.The reason for a medical check-up with an ophthalmologist may be:
- Cataract– clouding of the lens, for which it is recommended to visit an ophthalmologist 2 times a year.
- Glaucoma– increased intraocular pressure, which requires visiting a doctor at least 4 times a year.
- Retinal detachment and other lesions– consultation with an ophthalmologist is required at least 2 times a year ( if complications occur, an unscheduled consultation is indicated).
- Damage to the refractive system of the eye ( myopia, farsightedness, astigmatism) – examination by an ophthalmologist 2 times a year ( provided that before this a full diagnosis was carried out and corrective glasses or contact lenses were selected).
- Eye injury– regular ( weekly or monthly) examination by an ophthalmologist until complete recovery.
- Retinal angiopathy– you need to visit a doctor at least 1–2 times a year ( depending on the cause of the disease and the severity of retinal vascular damage).
When can an ophthalmologist admit you to the hospital?
The reason for hospitalization of ophthalmic patients is most often preparation for performing various surgical interventions on the structures of the eyeball ( on the cornea, iris, lens, retina and so on). It is worth noting that today most operations are performed using modern technologies, as a result of which they are low-traumatic and do not require a long stay for the patient in the hospital.The reason for hospitalization may be the severe course of the patient’s disease ( for example, retinal detachment in several places) or development of complications of the underlying disease ( for example, retinal hemorrhage, penetrating injury to the eyeball with damage to adjacent tissues, and so on). In this case, the patient is placed in a hospital, where he will be under constant medical supervision throughout the entire period of treatment. Before the operation, all studies necessary for an accurate diagnosis and determination of the surgical plan are performed. After surgical treatment, the patient also remains under the supervision of doctors for several days, which allows timely identification and elimination of possible complications ( for example, bleeding).
After discharge from the hospital, the doctor gives the patient recommendations regarding further treatment and rehabilitation, and also sets dates for follow-up consultations, which will allow monitoring the recovery process and identifying possible late complications.
How to get a sick leave certificate from an ophthalmologist?
A sick leave certificate is a document confirming that for a certain time the patient was unable to perform his job duties due to health problems. To receive a sick leave certificate from an ophthalmologist, first of all, you need to make an appointment with him and undergo a full examination. If the doctor determines that the patient cannot engage in his professional activity due to his illness ( for example, a programmer after performing eye surgery is prohibited from being at the computer for a long time), he will issue him the corresponding document. The sick leave certificate will indicate the reason for temporary disability ( that is, the patient's diagnosis), as well as the time period ( with dates), during which he is released from the work he performs for medical reasons.Is it possible to call an ophthalmologist at home?
Today, many paid clinics offer such a service as calling an ophthalmologist at home. This may be necessary in cases where the patient, for one reason or another, cannot visit a doctor at the clinic ( for example in the case of older people with limited mobility). In this case, the doctor can visit the patient at home, conducting a consultation and some vision tests. However, it is immediately worth noting that a full examination of the visual analyzer requires special equipment, which is available only in the ophthalmologist’s office, therefore, in doubtful cases, the doctor may insist on a second consultation at the clinic.At home, an ophthalmologist can perform:
- external examination of the eye;
- assessment of visual acuity;
- visual field examination ( approximately);
- fundus examination;
- measurement of intraocular pressure.
When an ophthalmologist refers you to other specialists for consultation ( oncologist, endocrinologist, ENT specialist, allergist, neurologist, cardiologist)?
During an examination of the visual analyzer, the ophthalmologist can determine that the patient’s vision problems are caused by a disease of some other organ or other system of the body. In this case, he can refer the patient for a consultation with an appropriate specialist to clarify the diagnosis and prescribe treatment for the underlying disease that caused the vision problems.The ophthalmologist may refer the patient for consultation:
- To an oncologist– if there is a suspicion of tumor diseases of the eye or adjacent tissues.
- See an endocrinologist– when detecting diabetic retinal angiopathy.
- To the ENT ( otorhinolaryngologist) – when identifying diseases of the nose or paranasal sinuses that could be complicated by eye damage.
- See an allergist– in case of allergic conjunctivitis ( lesions of the mucous membrane of the eye).
- To a neurologist– if there is suspected damage to the optic nerve or brain ( visual center) and so on.
- See a cardiologist– with retinal angiopathy caused by hypertension ( persistent increase in blood pressure).
What treatment can an ophthalmologist prescribe?
After making a diagnosis, the doctor prescribes to the patient various methods of correction and treatment of his existing disease. These methods include both conservative and surgical measures. Vitamins for eyes
Vitamins are special substances that enter the body with food and regulate the activity of almost all organs and tissues, including the organ of vision. An ophthalmologist can prescribe vitamins for chronic eye diseases, as this helps improve metabolism in the affected tissues and increases their resistance to damaging factors.An ophthalmologist may prescribe:
- Vitamin A– to improve the condition of the retina.
- Vitamin B1– improves metabolism in nervous tissue, including the retina and nerve fibers of the optic nerve.
- Vitamin B2– improves metabolism at the cellular level.
- Vitamin E– prevents tissue damage during various inflammatory processes.
- Lutein and zeaxanthin– prevent damage to the retina when exposed to light rays.
Eye drops
Eye drops are the most effective method of prescribing medications for eye diseases. When the medicine is instilled into the eyes, it immediately reaches the site of its action, and is practically not absorbed into the systemic bloodstream, that is, it does not cause systemic adverse reactions.For therapeutic purposes, an ophthalmologist may prescribe:
- Antibacterial drops– for the treatment of stye, chalazion, bacterial conjunctivitis and other infectious eye diseases.
- Antiviral drops– for the treatment of viral conjunctivitis and other similar diseases.
- Anti-inflammatory drops– to eliminate the inflammatory process in infectious and inflammatory eye diseases.
- Antiallergic drops– with allergic conjunctivitis.
Eye surgeries
For some diseases, a full-fledged surgical intervention is performed to eliminate defects in the visual analyzer.Surgical treatment in ophthalmology may be required:
- for diseases of the cornea;
- for lens transplantation;
- for treatment