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Routine vs. Medical Eye Exams: Which is Which?

What's the difference between a routine eye exam and a medical eye exam? Many patients and their families might be unclear on the distinction, so we're hear to break it down for you as simply as possible.

Routine Eye Exam

A routine eye exam is done to evaluate the visual acuity, the presence or absence of refractive errors (nearsightedness, farsightedness, astigmatism), and overall health of the eye, in children over the age of 5. If covered, this routine exam falls under your child's vision/eyecare insurance benefits.

Some issues that call for a routine eye exam include, but are not limited to:

  • Difficulty seeing the board

  • Difficulty reading

  • Failed vision screening by a school nurse or pediatrician in a child over the age of 5

  • Headaches not found to be associated with a medical problem

  • Frequent blinking or eye rubbing not found to have a medical basis

  • An annual regular eye check-up for preventive care

Medical Eye Exam

A medical eye exam in children employs the use of special techniques and equipment to detect potentially sight-threatening issues, and even medical problems which can be serious or life-threatening. This level of eye exam differs from a “routine” eye exam, in that it involves a higher level of complexity and decision-making by a pediatric eye care specialist. It is therefore billed differently, falling under medical insurance coverage rather than vision/eyecare coverage and subject to any applicable deductibles, co-insurance charges, and co-payments.

What does this mean in practice? An infant or young child may require a medical eye exam if “lazy eye” (amblyopia), crossed eyes (strabismus), or simply poor vision is suspected. This child cannot be accurately diagnosed without the special tools and expertise of a medical eye exam. Even if nothing is suspected, an infant or child this young simply cannot be accurately examined without the knowledge, skill, and experience of experts. A local chain or optical shop is inadequate for proper care of such a child.

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