10/03/2026
This afternoon, I want to repost, on WHAT, a basic Eye Test should be..and, I try to describe and explain, what Happens During an Eye Test
https://youtu.be/CLfzTSHCO5o?si=vK6FEIclQgZGbpcC
JJ Van Zyl Optometrists
What a Proper Eye Examination Should Really Include (And Why It Matters)
Many patients believe an eye test is simply about reading letters and choosing between “option one or two.” In reality, a thorough eye examination follows a carefully structured process designed to assess vision quality, eye coordination, and ocular health—all of which are essential for long-term comfort and clarity.
1. Case History:
The Foundation of Diagnosis
The examination begins with a detailed case history covering:
( HET JY dalk moeilike oë?)
• Visual symptoms (blur, headaches, eye strain, dizziness)
• Work and screen habits
• General health conditions
• Medication use
A critical step is not reviewing the old prescription beforehand, preventing subconscious bias and ensuring the new prescription is built entirely on current findings.
2. External Examination
THIS start the moment you walk into our practice as I’m watching how you walk, your posture, your head tilt and any type of clue about your vision - even before you enter my consulting room.
After the Case History, and, once you are seated in my test chair, I start to assess:
• Eyelids and lashes
• Eye alignment
• Facial symmetry and posture
ANYTHING, that, just by looking at your eyes, your skin, how you blink, your lashes might, give me more information about what is going on with your vision, your eyes and your general health! 
This step often also provides early clues about dry eye disease, lid abnormalities, or neurological issues.
3. Objective Refraction: Retinoscopy First
I always start my examination doing the objective examination first, using Retinoscopy - Before - subjective responses influence my thoughts and, possibly results.
This objective test establishes:
• Baseline refractive error
• Astigmatism axis
• Accommodation behavior
• Media clarity
It is especially valuable in children, diabetics, and patients with fluctuating vision.
4. Subjective Refraction: Refining the Prescription
Using the phoropter, and, now doing the subjective examination and, all patients know the story " What is better one or two " 😂😂 , I double check the objective results and do further testing on each eye and also checking for astigmatism, hidden eye strain and binocular vision. Basically, I'm also doing :
• Monocular refinement
• Jackson Cross Cylinder testing
• Duochrome confirmation
• Von Graefe binocular balancing
Cover tests are included to detect phorias or tropias that could affect comfort.
5. Trial Frame Confirmation
Rather than prescribing directly from the phoropter, the final prescription is placed in a trial frame.
This " trick " I learned in the UK where MANY practices are still using trial frame testing and especially, with large aperture trail lenses, I found it easy to watch the patient’s eyes when I’m doing further Binocular balancing tests , especially doing cover tests and specifically checking for any type of BVD problems!
This allows:
• Real-world viewing
• Rechecking alignment and balance
• Comparison with the old prescription
• Observation of eye posture and comfort
I also check the vision and comfort levels with the new found prescription in the trial frame. Not only in my consulting room but we also get the patient to have a look outside into the distance! - TO confirm stability and clarity.
6. Internal Eye Health Examination
Once visual performance and new Rx is confirmed, I would examine the inside of the eye :
HOWEVER, normally, by this time I would already have an idea what to expect when I do the internal eye examination.
Unfortunately, often as you grow older a vision loss does not simply mean that you need new spectacles, but it might also mean that you have some wear and tear behind the eye.
Traditionally, Optometrists would use an
ophthalmoscope. With this instrument we would come close to you and shine a light directly into your eye and observe the inside of your eye.
I also use a slit lamp with a Volk lens, and of course we can also use retinal cameras today.
In our area we are fortunate to have a group of Ophthalmologists close to whom we can refer any Emergency .
Basically, the internal examination evaluates the optic nerve, retina, macula, and blood vessels—crucial for detecting conditions such as glaucoma, diabetic eye disease, and retinal pathology.
7. Spectacle Frame and Lens Selection
This is OFTEN, the area where - even- if a great eye test has been done - where - things can rapidly go pear-shaped ...😳 😩
Even a perfect prescription can fail if:
• The frame is poorly sized
• Lens centration is incorrect
• The wrong lens material is chosen
Proper measurements and frame selection ensure the prescription performs as intended.
Summary :
A good eye examination is systematic, unbiased, and patient-centred. It balances objective findings with subjective comfort and confirms results under real-life conditions. This approach aligns with modern optometric best practice and professional bodies.
Clear vision is not just about seeing letters—it’s about seeing comfortably, efficiently, and safely every day.
What Tests Should a Optometrist Really Do?A proper eye examination is far more than just “reading letters on a chart.” A good optometrist follows a logical, ...
