10 Things Your Eye Doctor Won't Tell You

While optometrists say that their degree now covers all the skills needed to treat eye diseases, many M.D.s still argue it's no substitute for medical school. Which should you use? A rule of thumb: For regular checkups and problems affecting the outside of the eye, such as allergies or dry eye, an optometrist is sufficient. (Two sites for locating good ones: the American Academy of Optometry's, and the American Optometric Association's.) But if you experience symptoms such as loss of vision or flashing light, or if your optometrist finds signs of a cataract or macular degeneration, it merits a visit to an M.D.

2. "Hang on, just a few more tests. Papa needs a new speedboat."
Whether you see an optometrist or an ophthalmologist, most people should get their eyes checked about every two years, according to the AOA. A few tests are evergreen: the trusty eye chart, which gives a basic idea of what you can see; a refraction test, in which you look through a machine to determine your exact prescription needs; a cover test, using a paddle, which reveals how well your eye muscles work together; a test for glaucoma; and a "slit lamp" examination and retinal exam, which look for diseases inside your eye.

But some "routine" tests for otherwise healthy patients are probably unnecessary — especially if they're not included in the basic exam fee. A "visual field examination," in which a machine is used to check side vision, may be one such test, says Walter Beebe, M.D., a cornea specialist in Dallas. It can pick up advanced glaucoma or a brain tumor, he says, but unless symptoms or other signs warrant it, the test is probably not necessary. Another potential overkill fee: "photography of the eye." Many doctors will encourage it on the first visit, but, Beebe says, some want to repeat it every time. "It's hard to make a case for upwards of $100 for everybody who walks through the door," he says.

3. "Those $20 drugstore specs just might do the trick."
It's a relatively minor but annoying sign of middle age: Small print starts to get a little blurry, making those stock tables maddeningly hard to read. The medical term is presbyopia, a hardening of the crystalline lens, and it's becoming more common as a nation of aging baby boomers start squinting their way through dinner menus.

The solution many people quietly opt for is those drugstore reading glasses, which help magnify vision for a low-impact $10 or $20, versus five or 10 times that for prescription glasses. The problem with "drugstore readers" or "cheaters," says San Diego optician Carter Shrum, is that since they're mass-produced, the magnifying strength is the same for both eyes and is usually centered within each lens. That may be bad for you if that centering doesn't correspond well with the shape of your face or if, like many people, you have a different refractive error in each eye.

And like any mass-produced product, says Minnesota optometrist Kerry Beebe, some readers are better than others. A good eye doctor can suggest which ones are best for your situation, Beebe says, or he can analyze them "to check that the powers are what and where they're supposed to be."

4. "These lenses will make your head swim."
If you need bifocals but can't bear the idea of wearing lenses with etched-in lines, you have another option. Progressive lenses offer varied lens strengths like bifocals, but the varying prescriptions are graduated, so they're invisible to anyone but the wearer.

Other than cost ($200 or more for the lenses alone), some progressives have a major drawback: They can be difficult to get used to, causing dizziness, headaches, even teeth grinding as the eyes adjust. When San Diego human resources director Debi Ives first tried them, she got dizzy, had trouble focusing and lost her balance on the stairs. "I couldn't see where my feet were going," she says. Adjusting to progressives can take from a few minutes to two weeks or longer; if you experience problems, have your glasses checked to ensure they were ground and fitted properly — a good reason to ask about return and repair policies before you buy. A misplacement of the "near" zone, for example, can make a big difference. When Ives tried progressives again a year later, this time using larger lenses with less variation between zones, she was recoached on "pointing with her nose," rather than shifting her eyes to see different objects. "I've had much more success," she says.

5. "I have zero intention of handing over your contact lens prescription."
Since the late 1970s, eye doctors have been required by law to hand over your eyeglass prescription after an exam so that you can buy glasses wherever you want. It wasn't until early 2004 that they had to do the same with contact lens scripts.

Under the new law, a doctor can no longer require you to buy lenses from his office once the exam-and-fitting stage is complete. Char Pagar, an attorney with the Federal Trade Commission, points out that a contact lens prescription still isn't ready for release after an initial exam the way glasses are, but often requires one follow-up to ensure that the proposed lenses are right for you. However, "once the doctor is willing to sell you the lenses," Pagar says, "that fitting is complete."

But not all doctors are readily handing over the scripts. Some, Shrum says, "will lead patients into the dispensing place and hand [the prescription] to a person working there." If your doctor balks at giving you your script, first remind him of the law; if you still meet with resistance, you can file a complaint at www.ftc.gov. In October 2004 the FTC sent warning letters to 25 lens prescribers and sellers who were allegedly violating the rule.