When most people think about eye exams, they probably picture shopping for a new pair of glasses or getting their vision checked. You know the drill: you read letters on a chart, explore lens options with an optician, and maybe choose some stylish new frames while keeping your vision plan benefits in mind. However, there’s another important type of eye exam that is not as well known: the medical eye exam.
These two types of exams serve different purposes and are treated differently by eye care providers and insurance companies. Routine eye exams focus on keeping your vision sharp and your eyes healthy, while medical eye exams address specific eye conditions or symptoms. Let’s explore their key differences and help you understand when each is necessary and what to expect.
What is a routine eye exam?
A routine eye exam is probably what you’re most familiar with. Insurance companies define it as “an office visit to check vision, screen for eye disease, and/or update eyeglass or contact lens prescriptions.” These exams are vital for maintaining good vision and catching issues early. They’re typically scheduled annually or bi-annually, depending on your age and risk factors.
During a routine eye exam, our optometrist in Portland, ME will check your visual acuity (how clearly you see at a distance), look for early signs of eye diseases, and see if you need a new prescription. A key part of this exam is the refraction test. This is when your eye doctor asks, “Which is clearer: option A or option B?” to fine-tune your prescription.
Routine exams often result in diagnoses like nearsightedness, farsightedness, or astigmatism, which are considered vision issues rather than medical conditions.
What is a medical eye exam?
Medical eye exams are more specialized and focus on diagnosing, treating, or monitoring specific eye conditions or symptoms. Dr. Giles at Giles Eye Care performs these exams when you have a particular concern or are managing an existing condition. If you’re experiencing chronic eye pain or seeing flashes of light, for example, he will investigate the issue to determine the underlying cause.
Medical exams might lead to diagnoses like conjunctivitis, glaucoma, cataracts, or dry eye syndrome. These are medical conditions that need specific treatments or ongoing management.
Does vision insurance cover both types of exams?
Typically, vision insurance only covers routine eye exams and offers discounts on eyewear and contacts. For medical eye conditions, you’ll need to use your medical insurance, which generally covers medical exams, treatments, and follow-up visits for eye health issues. At Giles Eye Care, we accept most medical insurance plans, though the only vision plan we participate with is VSP (Vision Service Plan). It’s important to check with your insurance company before your appointment to confirm whether we’re in-network for your plan. For a list of accepted medical plans, please visit our insurance page.
It’s important to know that the type of exam might change based on what your doctor finds. You might come in for a routine exam, but if your optometrist spots a potential medical condition, the exam could be reclassified and billed as a medical exam. Alternatively, your doctor might schedule a separate medical exam to investigate further.
For more information or to schedule an appointment, reach out to Giles Eye Care. We offer comprehensive eye exams in Portland, Maine, and treatments for a variety of medical conditions, ensuring your eyes stay healthy and your vision clear!