A comprehensive eye exam is a full medical evaluation of the eye, performed by a physician who can diagnose disease, prescribe treatment, and operate if needed. It goes well beyond reading letters on a chart. The exam includes a detailed look at the structures inside and around the eye, measurement of internal pressure, assessment of how well your eyes work together, and screening for conditions that often develop without symptoms.
At Short Hills Ophthalmology, every patient receives this level of evaluation. Dr. Farbowitz and our team of ophthalmologists and optometrists use advanced diagnostic imaging alongside hands-on clinical examination to build a complete picture of your eye health. Whether you are coming in for an annual checkup, managing a condition like diabetes, or noticing a change in your vision you cannot explain, the exam is structured to find answers.
We see patients at two locations in northern New Jersey. Our Short Hills office is at 551 Millburn Avenue, and our Clifton office is at 777 Passaic Avenue.
What a Medical Eye Exam Covers
Your appointment begins with a review of your medical and ocular history, including medications, family history of eye disease, and any symptoms you have noticed. From there, the exam moves through a series of tests and evaluations, each one looking at a different part of how your eyes function and how healthy they are internally.
- Visual acuity and refraction measure how clearly you see at various distances and determine whether you need a new prescription for glasses or contact lenses. Refraction identifies myopia, hyperopia, astigmatism, and presbyopia with precision.
- Slit-lamp examination uses a high-magnification microscope with a thin beam of light to inspect the front structures of the eye. The cornea, iris, lens, and surrounding tissues are examined for signs of cataracts, corneal disease, inflammation, or infection.
- Dilated fundus examination involves drops that widen the pupil so the ophthalmologist can view the retina, optic nerve, and blood vessels at the back of the eye. This is where glaucoma damage, diabetic changes, macular degeneration, and retinal tears become visible. Dilation is one of the most important parts of a medical eye exam because many of these conditions produce no symptoms in their early stages.
- Intraocular pressure measurement checks for elevated pressure inside the eye, one of the primary risk factors for glaucoma. This is performed at every visit for patients over 40 and for anyone with a family history of the disease.
- Extraocular muscle testing evaluates how well your eyes move and align. Misalignment or restricted movement can indicate neurological conditions, thyroid disease, or muscle disorders.
The Difference Between a Medical Eye Exam and a Routine Vision Screening
A routine vision screening, often performed at a pediatrician's office, school, or retail optical shop, checks whether you can see clearly at a standard distance. It identifies obvious refractive errors and may flag the need for glasses. It does not evaluate the health of the eye itself.
A medical eye exam evaluates both vision and the physical condition of the eye. It includes dilation, pressure measurement, and a detailed examination of internal structures. An ophthalmologist performing this exam can detect glaucoma, diabetic retinopathy, macular degeneration, cataracts, corneal disease, and other conditions that a vision screening is not designed to find.
The distinction matters because many serious eye conditions develop gradually and painlessly. A patient who passes a vision screening with 20/20 acuity can still have early glaucoma, retinal damage from diabetes, or a growing cataract that has not yet affected the prescription. Only a medical eye exam performed by a qualified physician catches these.
At Short Hills Ophthalmology, every exam is a medical evaluation. Patients who come in expecting a simple glasses check receive the same thorough assessment as patients referred for a specific concern. Related reading: understanding the difference between an ophthalmologist, optometrist, and optician.
Diagnostic Imaging and Testing
The eye exam includes clinical observation by the physician, but it also relies on imaging technology that maps structures too small or too deep to evaluate with the naked eye alone. Our offices use several instruments that produce detailed measurements and images of the retina, optic nerve, cornea, and surrounding tissues.
These are not optional add-ons. Diagnostic imaging is part of how we identify conditions early, track changes over time, and make treatment decisions based on objective data rather than symptoms alone.
Optical Coherence Tomography (OCT)
OCT uses light waves to create cross-sectional images of the retina in microscopic detail. The scan is non-invasive, takes less than a minute, and requires no contact with the eye.
The resulting image shows individual retinal layers, allowing the ophthalmologist to detect thinning, swelling, fluid accumulation, or structural changes that indicate disease. OCT is the primary imaging tool for monitoring glaucoma, macular degeneration, and diabetic retinopathy. It also establishes a baseline measurement that future scans can be compared against, which is particularly valuable for patients with risk factors who have not yet developed visible symptoms.
For glaucoma patients, OCT measures the thickness of the retinal nerve fiber layer around the optic disc. Thinning in this area can signal damage before any vision loss is noticeable on a visual field test.
Visual Field Testing
A visual field test measures the full range of what you can see without moving your eyes, including peripheral vision. During the test, you focus on a central point while small lights flash at different locations across your field of view. You press a button each time you detect a light.
The results produce a map that identifies areas of reduced sensitivity or complete vision loss. This is the standard test for detecting and monitoring glaucoma, which typically affects peripheral vision first. Visual field testing also detects neurological conditions such as optic nerve damage, pituitary tumors, and stroke-related vision changes.
Patients with glaucoma or elevated eye pressure are tested at regular intervals, and the results are compared visit to visit to determine whether the condition is stable or progressing.
Tonometry and Additional Measurements
Tonometry measures the fluid pressure inside the eye, called intraocular pressure (IOP). Elevated IOP is one of the primary risk factors for glaucoma, though not the only one. The test is performed quickly and painlessly using either a brief puff of air (non-contact tonometry) or a gentle probe that touches the surface of the numbed cornea (applanation tonometry).
Several other measurements may be taken depending on the clinical picture. Corneal topography maps the curvature and shape of the cornea's surface. This data is used to fit contact lenses, plan refractive surgery evaluations, and diagnose corneal irregularities such as keratoconus. Pachymetry measures corneal thickness. Thinner corneas can produce artificially low pressure readings, which is relevant when assessing glaucoma risk. Fundus photography captures a high-resolution image of the retina and optic nerve head. These photographs create a permanent visual record that the physician uses to track changes in conditions like diabetic retinopathy and macular degeneration over multiple visits.
For a complete list of diagnostic equipment available at our offices, visit the testing and technology page.
Preventive Screenings That Protect Long-Term Vision
Several of the most sight-threatening conditions develop slowly, without pain, and without noticeable vision changes in their early stages. By the time a patient notices something is wrong, permanent damage may have already occurred.
Preventive screening during a comprehensive exam is how these conditions get caught while treatment can still make a difference. The ophthalmologist is not waiting for you to report a symptom. The screening is built into every exam for patients whose age or medical history places them at risk.
Glaucoma Screening
Glaucoma damages the optic nerve gradually, and the vision it takes does not come back. Most patients with early or moderate glaucoma have no symptoms at all. There is no pain, no redness, and central vision remains clear until the disease is advanced.
Screening involves three measurements that work together. Tonometry checks intraocular pressure. OCT imaging measures the nerve fiber layer around the optic disc. Visual field testing maps any areas of peripheral vision loss. No single test is sufficient on its own. A patient can have normal pressure and still have glaucoma, which is why the imaging and field testing matter.
Risk factors include age over 40, family history of glaucoma, African or Hispanic ancestry, high myopia, and elevated eye pressure. Patients with any of these factors are screened at every visit, and the results are tracked over time so the ophthalmologist can identify progression early.
At Short Hills Ophthalmology, glaucoma management ranges from medicated eye drops to in-office laser procedures, depending on the type and severity. Early detection through screening opens the widest range of treatment options.
Diabetic Eye Exams
Diabetes affects the blood vessels throughout the body, and the retina is one of the first places that damage becomes visible. Diabetic retinopathy occurs when high blood sugar weakens the small vessels in the retina, causing them to leak fluid, swell, or grow abnormally. Without treatment, it can lead to permanent vision loss.
Every patient with Type 1 or Type 2 diabetes should have a dilated eye exam at least once a year, regardless of whether their vision seems fine. The ophthalmologist examines the retina directly and uses OCT imaging to detect fluid, swelling, or early vascular changes that are not visible to the patient.
Diabetic eye exams also screen for other conditions that occur more frequently in diabetic patients, including cataracts and glaucoma. Results are coordinated with your primary care physician or endocrinologist so that systemic management and eye care stay aligned. Related reading: what to know about diabetic retinopathy.
If retinopathy is found, treatment options depend on the stage. Early-stage disease may require more frequent monitoring. Advanced cases may need laser photocoagulation or intravitreal injections performed at our offices.
Macular Degeneration Monitoring
Age-related macular degeneration (AMD) affects the central portion of the retina responsible for sharp, detailed vision. It is the leading cause of vision loss in adults over 60 in the United States.
AMD progresses through stages. Early AMD involves the buildup of small deposits called drusen beneath the retina. Intermediate AMD shows larger drusen and possible pigment changes. Advanced AMD takes two forms: dry (geographic atrophy) and wet (neovascular), with the wet form causing more rapid and severe vision loss.
OCT imaging and fundus photography are the primary tools for detecting and tracking AMD. These scans reveal drusen, pigment irregularities, fluid leakage, and structural changes in the macula with a level of detail that clinical examination alone cannot match.
Patients with early or intermediate AMD are monitored at intervals the ophthalmologist determines based on the findings. Nutritional supplementation following the AREDS2 formula may be recommended for certain stages. Wet AMD, if detected, is treated with anti-VEGF injections that can slow or stop further damage when started promptly.
Regular screening is the most effective tool against AMD because the early and intermediate stages produce no symptoms in most patients.
Common Conditions Diagnosed and Treated
Not every visit to an ophthalmologist involves surgery or a chronic disease diagnosis. A significant portion of the conditions we see and manage are everyday problems that affect comfort, clarity, and quality of life. Some resolve with a short course of treatment. Others require a prescription change or a straightforward in-office procedure.
The following are among the most frequent reasons patients visit our offices outside of surgical consultations and annual exams.
Refractive Errors and Prescription Changes
Refractive errors are the most common reason people need corrective lenses. They occur when the shape of the eye prevents light from focusing directly on the retina.
Myopia (nearsightedness)
Makes distant objects appear blurry while near vision stays clear. Typically develops in childhood and may continue to progress into the early twenties. Corrected with concave lenses in glasses or contact lenses, and in some cases may be addressed with refractive surgery once the prescription stabilizes.
Hyperopia (farsightedness)
Causes near objects to appear blurry, though distance vision may also be affected depending on severity. Mild hyperopia in younger patients is sometimes compensated by the eye's own focusing ability, which can mask the condition until it worsens with age.
Astigmatism
Results from an irregularly shaped cornea or lens that causes blurred or distorted vision at all distances. Frequently occurs alongside myopia or hyperopia and is corrected with cylindrical lenses, toric contact lenses, or refractive procedures.
Presbyopia
The gradual loss of the eye's ability to focus on close objects. Affects virtually everyone beginning around age 40 and progresses through the mid-sixties. Reading glasses, progressive lenses, or multifocal contact lenses are the most common corrections.
A change in your prescription does not always mean a worsening condition. However, rapid or unexpected shifts can occasionally signal an underlying issue such as early cataract development, elevated blood sugar, or corneal irregularity. The comprehensive exam is designed to distinguish a normal prescription update from something that warrants further investigation.
Eye Infections and Inflammatory Conditions
Conjunctivitis (pink eye) is an inflammation or infection of the transparent membrane lining the eyelid and covering the white of the eye. It can be bacterial, viral, or allergic in origin. Bacterial conjunctivitis typically responds to antibiotic eye drops. Viral cases are managed with supportive care and monitored for complications. Allergic conjunctivitis is treated with antihistamine drops and avoidance of triggers when possible.
Blepharitis is a chronic inflammation of the eyelid margins that causes redness, irritation, crusting, and a gritty sensation. It is frequently associated with bacterial overgrowth or dysfunction of the oil glands along the lash line. Treatment includes lid hygiene, warm compresses, and in some cases prescription drops or ointments. Persistent blepharitis may overlap with dry eye disease, which our dry eye clinic evaluates and treats separately.
Styes and chalazia are localized bumps on or near the eyelid caused by blocked or infected glands. A stye is an acute infection that usually resolves with warm compresses over several days. A chalazion is a non-infectious blockage that can persist longer and sometimes requires drainage in the office if it does not respond to conservative treatment.
Allergic eye conditions beyond simple conjunctivitis can include more persistent or severe forms of inflammation that affect the cornea. Patients with seasonal or year-round eye allergies may benefit from prescription-strength drops that go beyond over-the-counter options.
Floaters, Flashes, and Urgent Symptoms
Most floaters are harmless. They appear as small specks, threads, or cobweb shapes drifting across your vision and are caused by tiny clumps of gel inside the vitreous, the clear substance filling the center of the eye. As the vitreous naturally shrinks with age, these become more noticeable.
However, a sudden increase in floaters, especially accompanied by flashing lights or a shadow spreading across part of your vision, can indicate a retinal tear or detachment. This is a medical emergency. Retinal tears treated early with laser or cryotherapy have a high success rate. A retinal detachment that progresses without treatment can cause permanent vision loss.
If you experience a sudden onset of new floaters, flashes of light in your peripheral vision, or a curtain-like shadow across your field of view, contact our office immediately. Same-day evaluations are available for urgent symptoms at both our Short Hills and Clifton locations.
Patients who are highly myopic, have had previous eye surgery, or have a family history of retinal detachment are at higher risk and should report any new floaters or visual disturbances promptly.
Digital Eye Strain
Extended screen use affects the eyes in several measurable ways. Blink rate drops by as much as half during focused screen work, which reduces tear film coverage and leads to dryness and irritation. The sustained near-focus effort can cause fatigue in the ciliary muscle, producing blurred distance vision at the end of a long workday. Headaches and neck tension often accompany these symptoms.
Digital eye strain is not a disease. It does not cause permanent damage to the eye. But it is one of the most common complaints we hear, particularly from patients who spend eight or more hours a day on computers, tablets, or phones.
The 20-20-20 guideline: every 20 minutes, look at something 20 feet away for 20 seconds. Adjusting screen brightness to match ambient lighting, positioning the monitor slightly below eye level, and using preservative-free artificial tears during the workday can also reduce symptoms.
When these adjustments are not enough, the underlying cause may be an uncorrected refractive error, early presbyopia, or binocular vision dysfunction rather than screen habits alone. A comprehensive exam can identify whether a prescription adjustment or other treatment would resolve the problem.
Pediatric Eye Exams and Children's Vision
Children do not always tell you when they cannot see well. A child who has never experienced sharp vision at a distance may not know that what they see is blurry. School vision screenings catch some refractive errors, but they do not evaluate eye health, alignment, or the ability of both eyes to work together as a coordinated pair.
A pediatric eye exam performed by an ophthalmologist goes further. It evaluates visual acuity at all distances, checks eye alignment and tracking, screens for conditions that can affect visual development, and examines the internal structures of the eye.
When to Schedule the First Exam
The American Academy of Ophthalmology recommends that children have their first comprehensive eye screening between six and twelve months of age, with follow-up evaluations at age three and again before starting school. Children with risk factors such as premature birth, family history of childhood eye conditions, or developmental delays should be seen earlier and more frequently.
Amblyopia (Lazy Eye)
Develops when one eye has significantly better focus than the other, causing the brain to favor the stronger eye and suppress input from the weaker one. If caught early, amblyopia responds well to treatment with corrective lenses, patching, or atropine drops. Left untreated past the critical years of visual development, the imbalance can become permanent.
Strabismus (Eye Misalignment)
Occurs when the eyes do not point in the same direction. It may be constant or intermittent, and it can develop at any age in childhood. Treatment depends on the type and severity and may include glasses, prism lenses, vision therapy, or surgery.
Convergence Insufficiency
A common condition where the eyes struggle to turn inward together for near work, causing double vision, headaches, or difficulty reading. It is frequently misidentified as an attention problem in school-age children. A comprehensive exam can distinguish between a vision issue and a behavioral one.
Children with diabetes should follow the same annual dilated exam schedule recommended for adults. Myopia that progresses rapidly in childhood may benefit from management strategies that slow its advancement, which the ophthalmologist can discuss based on the individual case.
Glasses and Contact Lens Prescriptions
Refraction is performed during every comprehensive exam, and if corrective lenses are needed, you will leave with an up-to-date prescription. That prescription is yours. You can fill it at any optical shop, online retailer, or dispensary you choose.
Glasses Prescriptions
Include the sphere, cylinder, and axis measurements for each eye, along with any add power for bifocal or progressive lenses. The ophthalmologist or optometrist will discuss lens options if your prescription has specific characteristics that affect frame or lens selection, such as high myopia requiring thinner lens materials or progressive lenses for presbyopia correction.
Contact Lens Fittings
A separate appointment from the comprehensive exam. Fitting contacts requires additional measurements of corneal curvature, diameter, and tear film quality to determine which lens type and brand will sit properly on your eye. A trial period follows the initial fitting, and a follow-up visit confirms that the lenses are performing well and not affecting corneal health.
Specialty Contact Lenses
Available for patients whose needs go beyond standard soft lenses. Rigid gas permeable lenses and scleral lenses serve patients with keratoconus, high or irregular astigmatism, or corneal scarring. Multifocal contact lenses address presbyopia for patients who prefer contacts over reading glasses. The fitting process for specialty lenses takes longer and may involve multiple adjustments before the final parameters are set.
Patients who wear contact lenses should have a contact lens evaluation annually, even if the prescription has not changed. The ophthalmologist checks for corneal changes, oxygen deprivation, or early signs of infection that can develop from extended lens wear without causing obvious symptoms.
How Often Adults and Children Need Eye Exams
The recommended frequency of comprehensive eye exams depends on age, risk factors, and whether an existing condition is being monitored. The following guidelines are based on recommendations from the American Academy of Ophthalmology.
Children
Baseline screening between six and twelve months. Follow-up at age three, then before kindergarten. Every one to two years after that, or more frequently if glasses, contacts, or a diagnosed condition are involved.
Adults 18 to 39
At least one complete exam during this period if no risk factors are present. Every one to two years for patients with diabetes, family history of glaucoma, high myopia, or previous eye injury.
Adults 40 to 54
Baseline comprehensive exam at age 40. Follow-up every two to four years if no issues are found. Every one to two years for patients with risk factors. This is when glaucoma, cataracts, and macular degeneration first become detectable.
Adults 55 to 64
Every one to three years. Risk of cataracts, glaucoma, and macular degeneration increases significantly. Many patients transition to annual exams as conditions are identified and monitored.
Adults 65 and Older
Every one to two years. At this age, the likelihood of having at least one eye condition that requires monitoring is high. Annual exams are recommended for most patients.
Diabetic Patients (Any Age)
Dilated eye exam every year, starting at diagnosis for Type 2 and within five years of diagnosis for Type 1. Frequency increases to every three to six months if retinopathy is found.
Frequently Asked Questions About Eye Exams
What happens during a comprehensive eye exam?
The exam begins with a review of your medical and ocular history. You will then go through a series of tests including visual acuity measurement, refraction for your glasses or contact lens prescription, slit-lamp examination of the front of the eye, intraocular pressure measurement, and a dilated examination of the retina and optic nerve. Diagnostic imaging such as OCT or visual field testing may be included depending on your age and risk factors. The entire appointment typically takes 60 to 90 minutes when dilation is performed.
What is the difference between a medical eye exam and a routine vision screening?
A routine vision screening checks whether you can see clearly at a standard distance. It identifies refractive errors and determines if glasses are needed. A medical eye exam evaluates the health of the eye itself, including dilation, pressure measurement, retinal examination, and screening for conditions like glaucoma, macular degeneration, and diabetic retinopathy. An ophthalmologist performing a medical exam can diagnose disease, prescribe medication, and recommend surgical treatment when necessary.
How often should I get my eyes checked?
Adults with no risk factors should have a baseline comprehensive exam at age 40 and follow up every two to four years until age 54, then every one to three years until 64, and every one to two years after 65. Patients with diabetes, a family history of glaucoma, high myopia, or a history of eye surgery should be examined every one to two years regardless of age. Children should be screened between six and twelve months, at age three, and before starting school, with exams every one to two years afterward.
When should children have their first eye exam?
The American Academy of Ophthalmology recommends a first screening between six and twelve months of age. Children born prematurely, with a family history of childhood eye disease, or with developmental delays may need to be seen earlier. A follow-up exam at age three and another before kindergarten entry establishes a baseline for monitoring vision development through the school years.
What is an OCT scan?
Optical coherence tomography is an imaging test that uses light waves to create detailed cross-sectional pictures of the retina. It shows individual retinal layers and measures their thickness with microscopic precision. OCT is used to detect and monitor glaucoma, macular degeneration, and diabetic retinopathy. The scan is painless, takes less than a minute, and does not require any contact with the eye.
Why is a dilated eye exam important?
Dilation widens the pupil with eye drops so the ophthalmologist can see the retina, optic nerve, and blood vessels at the back of the eye. Many conditions that threaten vision, including glaucoma, diabetic retinopathy, macular degeneration, and retinal tears, are only visible through a dilated pupil. These conditions often cause no symptoms until they have already caused damage, which makes the dilated exam one of the most important parts of preventive eye care.
Does insurance cover a comprehensive eye exam?
Most medical insurance plans, including Medicare, cover eye exams performed by an ophthalmologist when the visit involves evaluation or management of a medical condition. This includes exams for patients with diabetes, glaucoma, macular degeneration, cataracts, and other diagnosed or suspected conditions. Routine vision-only exams for a glasses prescription may be covered under a separate vision plan. Our staff verifies your coverage before your appointment and can explain what your plan includes. For additional details, visit our insurance and financing page.
Your Eye Care Team
Dr. Lawrence Farbowitz is a board-certified ophthalmologist who has practiced in northern New Jersey for more than 30 years. He completed his ophthalmology residency at the University of Medicine and Dentistry of New Jersey and is a fellow of the American Academy of Ophthalmology.
Our team includes ophthalmologists and optometrists who work together to provide medical-level eye care across the full range of services described on this page. Every patient receives a physician-supervised evaluation, whether the visit is a routine annual exam or an evaluation of a specific concern.
Learn more about our providers on the doctors page.
Eye Care at Our Short Hills Office
Short Hills Ophthalmology has served the Short Hills and Millburn communities for over 30 years. Our Short Hills office provides comprehensive eye exams, diagnostic imaging, pediatric evaluations, contact lens fittings, and treatment for the full range of conditions described on this page.
Patients from Millburn, Summit, Maplewood, South Orange, Livingston, and surrounding Essex County towns are seen regularly at this location.
To schedule a comprehensive eye exam or discuss a specific concern, call our Short Hills office or request an appointment through our website.
Short Hills Office
551 Millburn Avenue
Short Hills, NJ 07078
Eye Care at Our Clifton Office
Our Clifton office serves patients throughout Passaic County and the surrounding areas of northern New Jersey. The same diagnostic equipment, exam protocols, and physician oversight available in Short Hills are available at this location.
Patients from Clifton, Passaic, Paterson, Nutley, Bloomfield, Lyndhurst, and neighboring communities are seen at this location.
To schedule a comprehensive eye exam at our Clifton office, call or request an appointment online.
Clifton Office
777 Passaic Avenue, Suite 485
Clifton, NJ 07012
Schedule a Comprehensive Eye Exam
Whether you are due for your annual exam, managing a condition, or concerned about a change in your vision, our offices in Short Hills and Clifton are accepting new and returning patients.
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