California Health Insurance Group Insurance Employee Benefits Worker Compensation

Eye Care - Exam Information

Eyeglass Examinations
The standard examination procedure for a patient who wants to wear eyeglasses includes at least the following:

Case history; reason for examination, patient medical and eye history, current medications, etc.
Recording of monocular (one eye) and binocular (both eyes) visual acuities at far and near, with and without present correction
Pupil responses (Neurological Integrity)
External examination findings (Biomicroscopy)
Internal examination findings (Ophthalmoscopy)
Present prescription (when applicable)
Retinoscopy (when applicable)
Subjective refraction
Phorometry/Binocular testing at far and near
Tonometry
Diagnosis/Prognosis
Specific recommendations

Contact lens examination
Examination requirements for patients who wish to wear contact lenses include all of the standard eyeglass examination procedures as well as the following:

Keratometry
Diagnostic lens testing (when applicable)
Additional external examination (biomicroscopy) with and without contact lenses
Series of follow-up visits to ensure compliance with maintenance and wearing schedules.

Providers generally assess higher charges for contact lens examinations than for eyeglass examinations. Some CMV benefit plans may require members to pay the difference between the usual and customary price for an eyeglass examination and the usual and customary price for a contact lens examination.

Dilation
Dilation is the enlargement of the pupil diameter, which allows the doctor to observe the internal eye more completely. It is not always part of a provider's standard examination procedure, but providers may perform dilation if any of the following conditions exist:

Diabetes
Myopia (nearsightedness) over 6 diopters
Hypertension (high blood pressure)
Retinal disease
Sudden changes in vision
Flashes or floaters
Family or personal health history that predicts future ocular complications
State law requiring dilation

Disease detection
During the course of an examination, an optometrist or ophthalmologist may detect abnormalities in the eye that are symptomatic of certain diseases that require treatment from another health care provider, such as diabetes or hypertension. In this case, the member will be referred to the appropriate medical provider based on their health plan.

Prescription
Prescriptions are often written following an examination to correct one of the following conditions:

Myopia
Myopia ("nearsightedness") is a condition in which light refracted into the eye focuses at a point in front of the retina. Myopic individuals can see objects clearly at near and have trouble seeing at far. Myopia is correctable with eyeglasses or contact lenses. Myopic correcting lenses are concave, or thinner in the center than on the edge.
Hyperopia
Hyperopia ("farsightedness") is a condition in which light refracted into the eye focuses at a point behind the retina. Hyperopic individuals can see objects clearly at far and have trouble seeing at near. Hyperopia is correctable with eyeglasses or contact lenses. Hyperopic correcting lenses are convex, or thicker in the center than on the edge.
Presbyopia
Presbyopia is the loss of focus ability due to the natural aging process. It is correctable with bifocal or trifocal lenses that reduce the need for the eye to focus when changing from far to near vision.
Astigmatism
Astigmatism is a condition in which an asymmetric cornea results in different visual irregularities in different parts of the eye. It is correctable with eyeglass lenses that are ground to a different thickness and curvature. Toric soft contact lenses or rigid contact lenses can also correct some cases of astigmatism.