Vision Exams and Insurance Benefits

According to the National Eye Institute, 10 percent of American adults have never had an eye exam, primarily because they don't think they have any vision problems. However, common eye diseases such as glaucoma, diabetic retinopathy, age-related macular degeneration and cataracts affect one out of eight Americans today. By 2030, that number is expected to increase by nearly 50 percent due to the large population of aging baby boomers.

Two of the biggest risk factors for ocular diseases are prolonged smoking and a family history of eye problems. In addition to those risks, more than 800,000 eye injuries occur in the workplace each year.

Many eye diseases and conditions can cause vision loss or blindness, so regular exams are key to early detection when they can be more easily and effectively treated. Americans are encouraged to get a regular, comprehensive eye exam and engage in healthy eye-care behaviors such as using protective eye wear in at-risk work environments, wearing sunglasses when outdoors, eating healthy foods, maintaining a healthy weight, managing chronic conditions, and quitting smoking.

Comprehensive Eye Exam
A comprehensive eye exam can take an hour or more and encompass far more than just optic tests for long and short distances. An eye care practitioner will take a close-up look at blood vessels, optic nerves, and other complex eye structures to look for clues that indicate more serious conditions, such as:

• High blood pressure
• Diabetes
• Aneurysm
• Autoimmune disorders
• Thyroid disease
• Sickle cell disease
• Liver disease
• Multiple sclerosis
• Parkinson's disease
• Other neurological or brain disorders
• Certain types of cancer

The following are tests that may be part of a comprehensive eye exam:

Color Blindness Test – A screen that checks color vision, which could indicate hereditary color vision deficiencies or certain eye health conditions.

Cover Test – Assess how your eyes work together by covering each eye alternately while focusing on a small object across the room, and then on an object that is nearby. If the uncovered eye must move to pick up the fixed target, this could indicate strabismus (abnormal alignment of the eyes that causes you to squint), amblyopia ("lazy eye"), or conditions that cause eye strain.

Ocular Motility Test – Determines how smoothly your eyes follow a moving object, and how quickly they move between and then focus on two separate targets. These issues can lead to eye strain and affect reading, sports vision and other skills.

Stereopsis (Depth Perception) Test – One common test for depth perception is to have the patient detect the closest pattern among a series of test patterns while wearing a pair of "3D" glasses. Correctly identifying the "closer" circle in each pattern indicates normal depth perception.

Retinoscopy – With this test the patient focuses on a large target (usually the big "E" on the eye chart) in a dim room while the eye doctor shines a light in each pupil while flipping lenses in a machine in front of the patient's eyes. This test approximates which lens power will best correct the patient's distance vision.

Refraction – The eye doctor determines a patient's level of hyperopia (farsightedness), myopia (nearsightedness), astigmatism (blurred vision), and presbyopia (farsightedness caused by loss of elasticity of the eye's lens). To determine exact prescription strength, he places a phoropter in front of the patient's eyes and asks which of the two lenses looks clearer. The doctor fine-tunes the lens power to reach a final eyeglass prescription.

Autorefractors – Like a manual refraction, an autorefractor determines the lens power required to accurately focus light on the retina by resting the patient's chin on the device while the doctor looks into the instrument at a pinpoint of light or a detailed image. This method is generally used to automatically estimate the eyeglass prescription for young children and other patients who may have trouble sitting still, as it takes only a few seconds.

Aberrometers – An aberrometer uses advanced wavefront technology to detect even obscure vision errors based on the way light travels through the eye. It is primarily used for custom or wavefront LASIK vision correction procedures, but some eye doctors use it in routine eye exams as well.

Slit Lamp Exam – A slit lamp is a binocular microscope (a.k.a., biomicroscope) used to examine the eyelids, cornea, conjunctiva, iris, and lens of eyes under high magnification. It requires that the patient place his forehead and chin on the front of the instrument, and can be used in conjunction with a hand-held lens to examine structures located farther back in the eye, such as the retina and optic nerve. This exam tests for a wide range of eye conditions and diseases such as cataracts, macular degeneration, corneal ulcers, and diabetic retinopathy.

Glaucoma Tests – Glaucoma typically does not present symptoms until significant loss of vision, so regular eye exams are important to detect early signs. The disease is detected by measuring the pressure inside the eyes, called the intraocular pressure (IOP). One test pushes a puff of air into the open eye while the machine calculates the patient's IOP based on his eye's resistance to the puff of air. High eye pressure indicates the potential risk for glaucoma.

Another glaucoma test involves placing yellow eye drops into the eye to numb it, then staring straight into a slit lamp while the eye doctor gently touches the surface of the eye with an instrument called an applanation tonometer to measure IOP. Both procedures are painless.

Pupil Dilation – This test enables a doctor to achieve the most thorough evaluation of the eye's internal structures by using eye drops to enlarge the pupils. It usually takes 20 to 30 minutes to dilate, at which point the patient will be highly sensitive to light and have difficulty focusing on up-close objects. During this time, the eye doctor will use various instruments to look inside the patient's eyes. This test is particularly important for people who have known risk factors for eye disease, such as smokers.

Visual Field Test – This test checks for blind spots (scotomas) in the patient's peripheral vision. Certain types of blind spots can indicate glaucoma or even brain damage caused by a stroke or tumor.

Contact Lens Fittings – While a comprehensive eye exam may determine the correct prescription for contact lenses, it usually does not include a contact lens prescription or fitting unless conducted by the patient's regular eye doctor who updates his current prescription.

In most cases, a contact lens exam and fitting services are provided during a subsequent visit when the patient's pupils are not dilated.

Vision Insurance and Discount Plans
Vision insurance and vision discount plans can help lower the cost of eye care and prescription eyewear. They are generally offered as an optional health policy by an employer. While often called vision insurance, these stand-along plans are usually just discount plans that reduce the cost of optical services and products, including LASIK and other elective vision correction surgical procedures. However, cataract and other medically necessary eye surgeries are usually covered by major medical and health insurance plans.

Adult vision services are not covered by health insurance plans offered via the Patient Protection and Affordable Care Act, although vision plans may be offered on the exchanges as stand-alone policies. Tax credits do not apply to stand-alone vision plans. Pediatric eye care (annual examinations, glasses, and contact lenses) is a required benefit in all healthcare plans that qualify as minimum essential coverage, although they may be subject to the plan's deductible requirements.

Medicare Coverage
Medicare does not cover routine eye exams for eyeglasses or contact lenses, although Part B may pay for some preventive and diagnostic tests, treatment for conditions such as glaucoma and macular degeneration, and cataract surgery. Once the beneficiary meets his deductible, he typically pays 20 percent of the Medicare-approved amount for eligible eye care services.

Coverage Makes a Difference
People who are covered by full-service, standalone vision insurance plans are two times more likely to get an annual comprehensive eye exam than those whose eye coverage is part of their major medical insurance plan.

Research has revealed that blue light from tablets and other mobile devices can increase the risk for macular degeneration. Moving forward, the aging population and the popularity of these blue light screen devices are likely to make the availability of vision plans all the more important and appealing to workers.

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