After age 65, you should have a comprehensive eye exam every one to two years, according to the American Academy of Ophthalmology. That baseline applies to healthy adults with no known eye conditions or major risk factors. If you have diabetes, a family history of glaucoma, or early signs of age-related eye disease, you’ll likely need exams more frequently.
The Standard Schedule for Healthy Adults
For most people over 65, an exam every one to two years is sufficient to catch problems early. The reason the recommendation tightens at this age is straightforward: the conditions most likely to steal your vision, including glaucoma, macular degeneration, and cataracts, all become significantly more common after 65. Many of these develop gradually and painlessly, so you can lose vision without realizing it until the damage is advanced.
Whether you land on the yearly or every-two-years end of that range depends on your overall eye health. If your eye doctor finds everything looks stable and you have no risk factors, every two years is reasonable. If there’s anything worth watching, such as mildly elevated eye pressure or early lens clouding, annual visits make more sense.
When You Need Yearly Exams (or More)
Several common conditions push the schedule to at least once a year:
- Diabetes. If you have type 2 diabetes, you should have had a screening at the time of diagnosis and at least yearly exams since. Diabetes can damage the tiny blood vessels in the back of your eye, and this damage can progress without symptoms. Annual screening catches changes early enough to treat them effectively.
- Glaucoma risk factors. Medicare considers you high-risk for glaucoma if you have diabetes, a family history of glaucoma, are African American and 50 or older, or are Hispanic and 65 or older. If any of those apply, yearly glaucoma screening is the standard.
- Early macular degeneration. If your doctor has spotted early signs of age-related macular degeneration, such as small deposits called drusen or pigment changes in the retina, monitoring intervals range from every 6 to 12 months. People with more advanced signs, like large, soft drusen combined with pigment changes, may need exams every 4 to 6 months to catch progression before it threatens central vision.
Your eye doctor will tell you exactly how often to come back based on what they find. If you’re managing any of these conditions, treat that personalized schedule as the one to follow rather than the general one-to-two-year guideline.
What Happens During the Exam
A comprehensive eye exam for someone over 65 goes well beyond reading letters on a chart. Expect the visit to take 30 minutes to an hour, and plan for blurry vision afterward if your pupils are dilated.
The key parts include an eye pressure check, where either a small puff of air or a gentle instrument tip measures the pressure inside your eye. Elevated pressure is one of the main warning signs of glaucoma. Your doctor will also put dilating drops in your eyes to widen the pupils, which lets them look directly at the retina and optic nerve in the back of your eye for signs of disease. A side-vision test checks for peripheral vision loss, another hallmark of glaucoma that you can develop without noticing on your own. Depending on what your doctor sees, they may order additional imaging to get a detailed map of your retina or a more thorough visual field test.
Dilation typically makes your vision blurry and light-sensitive for a few hours. Bringing sunglasses and having someone available to drive you home makes the visit easier.
What Medicare Covers
Here’s where many people get tripped up: Medicare does not cover routine eye exams for glasses or contact lens prescriptions. You pay the full cost for those out of pocket.
What Medicare does cover are medical eye exams tied to specific conditions. If you qualify as high-risk for glaucoma, Medicare covers a glaucoma screening once every 12 months. It also covers eye exams related to diabetes and testing and treatment for macular degeneration. The distinction matters because the same physical exam can be billed differently depending on whether it’s considered “routine” or “medical.” If you have diabetes, glaucoma risk factors, or a diagnosed eye condition, make sure your eye doctor’s office knows so the visit is coded correctly and Medicare picks up its share.
Many Medicare Advantage plans offer broader vision benefits, including routine exams, so check your specific plan details if you’re enrolled in one.
Symptoms That Need Immediate Attention
No matter where you are in your exam schedule, certain vision changes require urgent care, not a wait-and-see approach. Sudden vision loss in one or both eyes is a medical emergency. This includes losing vision entirely, losing part of your visual field (like your peripheral or central vision going dark), or a rapid, unexplained blurriness that comes on over seconds, minutes, or a few days.
New floaters, especially a sudden shower of them, flashes of light, or a shadow or curtain effect across your vision can signal a retinal detachment or another serious problem. These warrant a same-day call to your eye doctor or a trip to the emergency room, whether or not you have eye pain. Getting evaluated quickly can be the difference between preserving your vision and losing it permanently.