What are the different types of exams?

In the past, there was only one type of examination performed when you had your eyes checked. Now, because of government, Medicare, and insurance regulations, different types of exams are done for different purposes. In general these exams are:

Eye Examination. This is the traditional examination of the eyes and related structures intended to detect, discuss, and treat eye problems and diseases. If you have an eye problem, this type of examination is usually partially covered by Medicare and health insurance. Screening examinations, in which you have no eye problem, are often not covered. A Refraction for glasses is not included in an Eye Examination but upon your request it may be done during the same visit and billed separately.

Refraction (Glasses Examination). This is a record of the patient’s preference for the focusing of the eyes which may then be used to purchase glasses. According to Medicare law and the policy of most insurance companies, a Refraction is not included in the approved fee for an Eye Examination and we are required to bill the patient separately for the Refraction. Since most patients come to us because of eye problems, we do not perform nor charge for a Refraction unless requested by the patient. Please tell us if you want a Refraction in addition to an Eye Examination.

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Contact Lens Fitting. This includes the measurement of the shape of the eye, fitting of the contacts, and checking to be sure the contacts fit properly. It is performed after a Refraction and Eye Examination and is separate from the purchase of the contact lenses.

Vision Examination. This is a new type of examination advertised by some insurance companies. Unfortunately, a few companies have disclosed the restrictions only in the fine print. It includes a Refraction and limited screening of the eyes which may or may not detect diseases. A Vision Examination never includes any discussion or treatment of eye problems and is not intended for anyone with an eye problem. People with eye problems who schedule a Vision Examination would then need a separate Eye Examination to evaluate the problems. This may be more expensive than if the patient had scheduled an Eye Examination plus a Refraction. Patients who have Vision Examinations are encouraged to have occasional Eye Examinations to look for conditions which may cause later problems.
 

What is the difference in an Eye Examination and a Refraction?

An eye examination is a study of the eyes and neurological visual system to detect, discuss, and treat diseases or, in some cases, the potential for future disease or loss of vision. A refraction is a record of the patient’s preference for the focusing of the eyes which may then be used to purchase glasses. According to Medicare law and the policy of most insurance companies, a Refraction is not included in the approved fee for an Eye Examination and we are required to bill the patient separately for the Refraction.  Click here to review the different types of exams.
 
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What is the difference in Medical Insurance and Vision Insurance?

Medical Insurance generally covers evaluation and treatment of diseases. The medical insurance that covers your eyes is the same insurance that covers you for any other disease such as colds, heart attacks, operations, or any other medical problem. Medical insurance usually will not cover a screening examination, in which you have no problem. The most common eye problems we see (which are covered by almost all medical insurance) are irritated or burning eyes, decreased vision caused by an eye problem, cataracts, glaucoma, diabetes, and eyelid problems.

Vision Insurance just covers a Vision Examination for a Refraction and limited screening of the eyes which may or may not detect diseases. A Vision Examination never includes any discussion or treatment of eye problems and is not intended for anyone with an eye problem. Vision insurance will sometimes cover a limited screening examination in which you have no problem. If you come in for an examination under your vision insurance, and are found to have an eye problem, you will need another examination under your Medical Insurance to evaluate the problem. This may cost more than a medical examination plus a refraction, so people who know of an eye problem should generally schedule a medical examination instead of a vision exam.

Click here to review the different types of exams.
 
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How are charges for medical services determined? And by whom?

In general, the short answer is that they are set by a Medicare committee in Washington. This committee sets the fees for Medicare directly, but then insurance companies often follow Medicare’s lead. Also, according to Medicare law, we are forbidden to charge anyone else less than the Medicare rates. The feeling that this system is complicated and arbitrary is the main reason cited by physicians who retire early, quit seeing Medicare patients, or pursue other careers.

For many years we have tried to save our patients money by accepting assignment on Medicare and some insurance programs. "Accepting assignment" means we follow the fee schedule set by Medicare or the insurance company so our patients will not have any costs above those set by the program.

A US Government agency, the Health Care Finance Administration (HCFA), sets the Medicare fees for all medical services.  Over the last several years a HCFA committee in Washington has determined that exam fees are too low and surgery fees are too high. They have increased the exam fees and cut surgery fees to one third of the level existing 15 years ago when fees were set by the free market. They point out that the changes are supposed to be "budget neutral" with total costs not changing, but shifting from lower surgery fees to higher exam fees.

Many physicians strongly disagree with this concept and feel that exam fees, which patients pay frequently, should be kept lower and surgery fees, paid rarely by most people, higher. Medical organizations argued vigorously against the changes, but we lost. Thus, HCFA will again increase exam fees and decrease surgery fees this year. If we are to continue accepting assignment, we have no choice but to follow their new fee schedule.

Because of these changes and other problems, some physicians have quit seeing Medicare patients and others have retired. We intend to continue helping Medicare patients so we, along with physicians all across the United States, will follow their schedule of higher exam fees and lower surgery fees.
 
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What is your charge for an eye exam?

According to the Medicare fee schedule which we are required to follow for all patients if we see any Medicare patients, the fees range widely depending on the type of exam and how long since you were last seen by a particular doctor. Please see the section about how a Medicare committee sets fees nationally for all patients, not just those with Medicare. Please call the office to ask about the most common fees set by the Medicare committee for various types of exams. If a patient explains financial difficulty to us, we have always given discounts or free care as needed.

Click here to see how Medicare sets the fees for most physicians even for patients not covered by Medicare.
 
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Why is the cost for a contact lens fitting separate from the exam?

In the past, all parts of an examination and contact lens fitting (Eye Examination, Refraction, Contact Lens Fitting, and contact lens purchase) were grouped together with one required charge for the entire procedure. Now, it is considered more fair to allow patients to choose which parts of the process they wish to have. You are now charged only for those parts you want. For example, you may already have had the examination and refraction elsewhere, but you want to have the fitting at Robinson Eye Institute. Or, a student in college elsewhere may want the exam and refraction at REI and then may want to be fitted and to purchase the lenses in the college city.

The Contact Lens Fitting includes the measurement of the shape of the eye, fitting of the contacts, and checking to be sure the contacts fit properly. It is performed after a Refraction and Eye Examination and is separate from the purchase of the contact lenses.
 
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What is a Certified Ophthalmic Assistant

A Certified Ophthalmic Assistant is a person who has worked in an ophthalmology office, studied an extensive curriculum concerning ophthalmology and vision, and then passed a multi-part examination by The Joint Commission on Allied Health Personnel in Ophthalmology®.
 

Robinson Eye Institute, P.C.

Disease and Surgery FAQ

Am I a candidate for LASIK?

Whether you are a candidate or not depends on your refraction and age.  Myopic LASIK (for nearsightedness) works best with refractions of less than -8 diopters but will usually work up to about -11 diopters.  Hyperopic LASIK (for farsightedness) works with refractions of less than about +3 or +4 diopters but will work up to about  +5 diopters.  Astigmatism of up to about 4 diopters can be corrected.  In all cases, results are less accurate and healing takes longer with the higher amounts of correction.  Patients must be 18 years old but should be 21 for best results.  The refraction must have been stable for at least a year.
 
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What are cataracts and implants?

A cataract is any cloudiness of the lens inside the eye which causes the focused vision to be unclear. The cornea is the round, clear front of the eye and through this the blue or brown iris can be seen. The central hole in the iris is called the pupil. Just behind the iris is the lens which is very nearly the size and shape of an M & M candy.

Normally the lens is clear, but if it becomes white or cloudy it can sometimes be seen through the pupil with just a flashlight. This cloudiness is called a cataract. Therefore, a cataract is neither "on," nor "behind" the eye, but is inside the eye.

After the cataract is removed, a tiny plastic intraocular implant lens is placed in the position from which the natural lens was removed. The implant is permanently placed inside the eye, so it does not need handling, adjusting, or cleaning. With our delicate instruments, we can perform the entire operation through an incision less than 1/4 inch long. If a person has always required thick glasses, we can select an implant lens power so they will not require the thick glasses after surgery.

Implants can now be placed even years after the original cataract operation. Many people who had cataracts removed years ago now request the secondary implants if they have difficulty with thick cataract glasses or contact lenses.
 
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Do you remove cataracts with the laser?

Somewhere an untrue rumor started that lasers are used to remove cataracts. The best explanation for this rumor is that some patients felt a laser sounded more impressive to their friends.

Cataracts are removed with a thin ultrasonic needle vibrating over 40,000 times per second. Lasers are used in the office for glaucoma, diabetic eye disease, refractive surgery, and rarely even to soften cataracts, but never to remove them. A laser is a specialized light beam. An ultrasonic needle uses specialized sound waves. Some ultrasonic needles for cataract surgery use a laser in their power supply, but not to remove the cataract. Some people confuse cataracts and glaucoma, but they are entirely separate diseases.
 
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What is glaucoma and how is it treated?

The glaucomas are diseases in which pressure inside the eye damages the optic nerve so it no longer conducts vision from the eye to the brain. Glaucoma is damage to the optic nerve, not simply elevated eye pressure. The optic nerve is very much like a cable going to a television. No matter how good the TV camera and set are, if the cable is damaged, no picture will appear.

The glaucomas can be caused either by the eye pressure being too high, or by the blood vessels or nerve cells being unusually sensitive to damage. This is why there is no "normal" pressure that is safe for everyone.

Certain conditions such as blood vessel disease, diabetes, high nearsightedness, advanced age, race, and having several relatives with glaucoma make glaucoma more likely. People with African ancestry are eight times more likely to have glaucoma than Europeans and about 10% of black people over age 65 have glaucoma. About 2 million Americans have glaucoma, but only half know it.

The most common type of glaucoma is called open angle, because the fluid can flow freely inside the eye. Open angle glaucoma generally progresses slowly over years. A more dangerous form is narrow angle glaucoma in which the iris partly blocks the drainage of fluid from the eye. Secondary glaucoma occurs because of damage to the eye from injuries, diabetes, strokes, and other causes. It can be extremely difficult to treat. Congenital glaucoma, found in babies and children with a birth defect in the filtration system, is quite rare.

The treatment depends on the type of glaucoma, and may include eye drops, laser surgery, or filtration surgery. Laser surgery is done in the Laser Suite at Robinson Eye Institute and may be to lower the pressure, open fluid pathways, or control blood vessel growth.

The glaucomas can be very complex to treat, but with careful treatment and lifelong observation, good vision can be preserved in most cases. The most difficult cases are those which are not detected until already severe. That is why periodic dilated examination of the optic nerve to detect glaucoma is so important.  

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Robinson Eye Institute, P.C.

Optical Galleria™ FAQ

Do you sell glasses?

Yes, the Optical Galleria™ in Robinson Eye Institute has become known as one of the largest and most prestigious professional optical departments in Oklahoma. We also have many styles of contact lenses available. We have two certified opticians and others in the process of obtaining certification. Our Optical Galleria™ has over one thousand of the latest frame styles and a large selection of new lens technologies. We have patients from many areas of Oklahoma as well as from other states who routinely come to the Optical Galleria for their optical needs because they appreciate the level of quality.
 
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What is a Certified Optician?

A Certified Optician is one who has studied and practiced opticianry and then passed a multi-part examination by the American Board of Opticianry. Our Optical Galleria™ has two certified opticians. There is no requirement in Oklahoma for an optician to be certified and many are not. Our certified opticians are often asked by patients to sort out problems with glasses purchased elsewhere when the seller did not have the training to evaluate the problem. People may have seen the ABC 20/20 program about the problems patients have with glasses purchased from places without a certified optician. Many patients come to our Certified Opticians for special or difficult optical needs. A Certified Optician allows patients to access intelligent use of today’s optical technology.
 
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What are the feather type lenses?

They are made of polycarbonate, an older and widely available material, but still very important since it forms the most impact and shatter resistant lenses. Polycarbonate lenses are light weight and thin, but newer technology lenses have better optics. The Robinson Eye Institute Optical Galleria™ features the ComfortLite™ lenses which are thinner, lighter, and have better optics.
 

Why are some frames and lenses cheaper than others?

Materials, technology, and the skill level of the people making the glasses determine the durability, comfort, and cost of the glasses. Some people will be happy with cheaper assembly line glasses, but others want higher levels of quality. Craftsmanship and quality control result in better eyeglasses just as in carpentry, jewelry, machinery, and any other highly skilled trades. Generally the best educated and most experienced craftsmen produce a better product. You still get what you pay for.
 
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Can I put new lenses in my old eyeglass frame without leaving them?

Yes, we have a computer which makes an exact tracing of your frame and then stores all the information and a pattern of your frame. You can wear your eyeglasses while we manufacture the lenses, then we will put them in your frame while you wait, which usually takes less than ten minutes. This is much more exact than the old method of using a pre-made pattern to fit all frames of a certain model. That method often resulted in lenses that did not exactly fit a particular frame. Each individual frame in a model line will be slightly different from others so the individualized frame tracing results in a more exact fit.
 

What are Computer glasses?

Computer glasses are a specific powered pair of lenses that focus at precisely the correct distance to see the computer screen and the keyboard.   If you are having trouble seeing, or are having eyestrain while using the computer you may be a candidate for these special glasses.  These glasses often have a relaxing tint or anti-reflection coating.  Check with your doctor or optician to order these.

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Robinson Eye Institute, P.C.

Audiology and Hearing FAQ

What is the difference between an Audiologist and a hearing aid dealer?

An Audiologist is a health specialist with at least a college degree and a Masters Degree in Audiology who tests the full hearing system and then recommends devices to return hearing and comprehension as close to normal as possible. Audiologists are licensed by the state and are certified by the American Speech and Language Association.

Did you know that some people selling hearing aids are not professional audiologists? Patients have often told us of buying hearing aids from dealers without having an audiology evaluation and then being disappointed in the result. These patients did not know they could have an evaluation by a highly educated audiologist before purchasing any devices.

To help save these patients the grief and expense of inadequate hearing devices, the Robinson Eye Institute has cooperated with the University of Oklahoma Section of Audiology to construct an advanced hearing evaluation suite. The OU Section of Audiology uses this suite containing the latest in computerized evaluation equipment as the Shawnee branch of their Oklahoma Health Sciences Center program.

Stephen W. Painton, Ph.D., Clinic Director of Audiology Services at the OU Health Sciences Center in Oklahoma City, is in charge of the branch at Robinson Eye Institute. Dr. Painton is a Professor of Audiology with 25 years experience. He has written numerous audiology articles, and has presented educational lectures to audiologists across the country. Dr. Painton also has a Doctorate in Audiology (Ph.D.) since he teaches other Audiologists.

Many patients have told us how happy they are that these services are now available in Shawnee without driving into Oklahoma City. Audiologists are separate from the highly advertised hearing aid dealers who are not required to have either a college degree or masters degree in Audiology.

Patients who have the professional audiology evaluation and then obtain a hearing aid through our arrangement with OU are allowed to use it for 30 days at home to determine if they are helped. If you would like to have an audiology evaluation by Dr. Painton before purchasing a hearing aid, please call Robinson Eye Institute at 405-275-7400 or 800-722-0111 for an appointment.

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