An eye chart.

W hen was your last eye exam?

About 1 in 5 Americans ages 50 to 80 hasn’t had one in the past two years, according to a recent University of Michigan poll. That may not be often enough.

More on eye health

People 65 and older should have an eye exam at least every other year, and those 55 to 64 every one to three years, according to the American Academy of Ophthalmology (AAO). (If you have a personal or family history of eye disease or a condition that increases the risk of vision problems, talk with your doctor.)

Regular eye exams are especially important with age, when the risk of conditions such as cataracts, glaucoma, diabetic retinopathy, and age-related macular degeneration (AMD) rises.

“All of these are at least treatable—and some curable—if caught early,” says Hilary Beaver, M.D., an ophthalmologist and cataract surgeon at Houston Methodist Hospital in Houston and an associate professor of clinical ophthalmology at Weill Cornell Medical College in New York.

But “most medical insurance plans don’t cover routine checks of your vision and eye health if you don’t have symptoms or signs of disease,” says Adam Gordon, O.D., a clinical associate professor at the University of Alabama at Birmingham School of Optometry. (Vision insurance may be an add-on to your policy.)

Insurance generally covers exams for those with—or at risk for—certain conditions, and to diagnose symptoms. But routine exams can cost $150 or more out of pocket. In addition, Beaver says, some eye doctors may recommend high-tech imaging tests that can add about $100.

What Should an Exam Cover?

During a routine exam, a vision-care technician will often check your eyesight, peripheral vision, and your eyes’ ability to work together and move in all directions.

A doctor will then use a lighted microscope (slit lamp) to inspect your outer eye. For a look inside, and to check your retina and optic nerve, the doctor will use drops to dilate your pupils. He or she will also look for signs of eye disease.

What About High-Tech Tests?

In recent years, high-tech imaging tests have become available. They use computerized equipment to, say, produce highly detailed images of the eye.

“Imaging tests can be useful for diagnosing symptoms or following up on suspicious findings from an exam,” Gordon says. For example, if you have glaucoma, a visual field machine can detect vision loss more precisely than the traditional method.

High-tech imaging tests are generally unnecessary unless you have signs of significant eye disease, the AAO says. But some practices offer them for routine exams, says Beaver, even though they provide no additional information and could yield misleading results. Plus, medical insurance usually doesn’t cover these tests if you have no symptoms; vision plans may or may not.

A possible exception: Instead of dilating your eyes during a routine exam, a high-tech camera can produce a magnified image of the back of your eye. (The test can cost $20 to $40.) It’s “a reasonable option for people at low risk of eye disease who don’t want to deal with a few hours of blurry vision,” Gordon says. But an exam with dilation is considered more thorough and accurate, and is recommended for people at risk for or diagnosed with eye disease.

Which Eye Doctor Should You See?

Ophthalmologists have a doctor of medicine (M.D.) or doctor of osteopathy (D.O.) degree, with four years of medical school and several years of residency and specialized training. Optometrists have a four-year doctor of optometry (O.D.) degree.

How to choose?

For routine exams and prescriptions for contacts or glasses: Either. Some optometrists specialize in fitting medically necessary contacts, such as for people with scarred corneas.

For symptoms such as dry eyes, an infection, or pain: Either. Good optometrists will refer you to an ophthalmologist if the problem is beyond their scope of practice. (State laws vary on which conditions optometrists can treat.)

For serious eye disease or any eye surgery: Ophthalmologists. They’re licensed to do surgery and treat all eye diseases. 

Editor’s Note: This article also appeared in the March 2019 issue of Consumer Reports On Health. It was updated to add additional information to Dr. Beaver's affiliation.