When you think about scheduling an eye exam, you probably picture the usual routine. You read the letters on the eye chart, get your eyes examined for signs of issues, answer “Which is better, one or two?”, and maybe pick out new frames while considering your vision benefits. But did you know your eye doctor might also recommend a medical eye exam in certain cases? Routine eye exams focus on vision and general eye health, while medical eye exams are for specific concerns or diagnosed conditions.
Many people don’t realize that these two types of exams serve different purposes and are billed differently by insurance providers. Understanding the difference can help you make the best decisions for your eye health—and avoid unexpected costs!
What is a routine eye exam?
A routine eye exam is what most people think of when they schedule an eye appointment. Your eye doctor checks your vision, determines if you need prescription glasses or contact lenses, and ensures your eyes are healthy. These exams are usually recommended once a year or every two years, depending on your age, vision needs, and risk factors.
During a routine eye exam, your optometrist will:
- Test your visual acuity (how clear you see at a distance)
- Perform a refraction test to determine your prescription (this is when they ask, “Which is better, one or two?”)
- Screen for early signs of eye diseases
Routine exams typically lead to diagnoses such as nearsightedness, farsightedness, or astigmatism—conditions that impact vision but are not considered medical problems.
What is a medical eye exam?
A medical eye exam is necessary when you have symptoms of an eye condition or are managing an existing diagnosis. These exams focus on diagnosing, treating, and monitoring eye diseases and other medical issues affecting your vision.
You might need a medical eye exam if you experience symptoms like:
- Eye pain
- Sudden vision changes
- Flashes of light or floaters
- Redness, irritation, or excessive dryness
Common conditions diagnosed during a medical eye exam include glaucoma, cataracts, diabetic eye disease, conjunctivitis (pink eye), and dry eye syndrome. Unlike routine exams, medical eye exams may require follow-up visits and specialized treatments.
Do vision plans cover both types of exams?
No, vision plans and medical insurance cover different types of care:
- Vision plans typically cover routine eye exams and may offer discounts on glasses and contact lenses.
- Medical insurance covers medical eye exams and treatment for diagnosed conditions.
Sometimes, a routine exam may turn into a medical exam if your optometrist identifies a health concern. In such cases, your visit may be billed through your medical insurance instead of your vision plan, or you may need to schedule a separate appointment.
The bottom line
In conclusion, routine eye exams help maintain clear vision and overall eye health, while medical eye exams address specific conditions requiring diagnosis and treatment. At Newport Eye Care, we provide both routine and medical eye exams in Newport and Waterville, Maine. If you have any questions or need to schedule an appointment, contact us today! Before your appointment, be sure to visit our insurance page to verify your coverage.
