Usually, when we think of eye exams, we think of updating our glasses prescription or checking our vision. You know the routine: you read letters from a chart, the doctor asks if option 1 or option 2 is better, you meet with the optician to discuss lens options, and maybe you choose new frames while considering your vision insurance benefits. However, there’s another type of eye exam that’s equally important but not as well known: the medical eye exam.
Many people aren’t aware that these two types of eye exams serve different purposes and are handled differently by eye care providers and insurance companies. Routine eye exams focus on vision and general eye health, while medical eye exams address specific eye conditions or symptoms. In this blog, we explore the key differences between routine and medical eye exams, helping you understand when each is necessary and what to expect.
What is a routine eye exam?
A routine eye exam is the type most people are familiar with. Insurance companies define a routine eye exam as “an office visit to check vision, screen for eye disease, and/or update eyeglass or contact lens prescriptions.” Routine eye exams are essential for maintaining good vision and catching potential issues early. These exams are typically scheduled annually or bi-annually, depending on your age and risk factors.
During a routine eye exam, your optometrist will assess your visual acuity, check for early signs of eye diseases, and see if you need an updated prescription for glasses or contacts. A key component of routine exams is the refraction test. This is where you’ll hear the familiar question, “Which is clearer: option A or option B?” as your eye doctor switches back and forth between lenses to determine your exact prescription.
Routine exams typically result in diagnoses such as nearsightedness, farsightedness, or astigmatism. These are considered vision issues rather than medical conditions.
What is a medical eye exam?
Medical eye exams, on the other hand, are more specialized and focus on diagnosing, treating, or monitoring specific eye conditions or symptoms. These exams are performed when you have a particular concern or are following up on an existing condition. For example, if you’re dealing with chronic eye pain or seeing flashes of light, your eye doctor will investigate these issues.
Medical exams might lead to diagnoses such as conjunctivitis (pink eye), glaucoma, cataracts, or dry eye syndrome. These are considered medical conditions that require specific treatment or ongoing management.
Does vision insurance cover both types of exams?
No, vision insurance typically only covers routine eye exams, not medical eye exams. Most vision plans also provide discounts on eyewear and contact lenses. If you are visiting an eye doctor for a medical condition, you will need to use your medical insurance. Medical insurance usually covers medical eye exams, treatments for eye conditions, and follow-up visits for existing eye health issues.
It’s important to note that the type of eye exam you receive may not always match the reason you went to the eye doctor in the first place. For example, you might come in for a routine eye exam, but your optometrist discovers signs of a medical condition while examining your eyes. In these cases, the exam could be reclassified and billed as a medical exam, or your eye doctor might schedule a separate medical eye exam to investigate the issue further.
The bottom line
In summary, routine exams focus on preventative care and vision correction, while medical exams provide necessary care for specific eye conditions. If you’re unsure about what your insurance policy covers, it’s best to check your plan’s statement of benefits or contact your provider directly.
For more information or to schedule an appointment, contact us at Advanced Vision Care and Cedar Hill Eye Care. We offer eye exams in Mansfield, Fort Worth, DeSoto, and Cedar Hill, along with treatment for a range of medical conditions, to help you keep your eyes healthy and your vision clear!