Most people visit their dentist twice a year without question. They see their GP when something feels wrong. They service their car on schedule. But their eyes — the organs they rely on more than any other — are often neglected until a problem becomes impossible to ignore.

The two most sight-threatening conditions in ophthalmology — glaucoma and diabetic retinopathy — produce no symptoms in their early stages. The condition that causes the most severe vision loss in people over 50 — macular degeneration — often begins with changes so subtle they are easy to dismiss. The common thread is that early detection changes outcomes dramatically, and early detection depends on one thing: a routine eye examination before symptoms appear.

This guide explains how often you should have your eyes examined at every stage of life, and what those examinations are looking for.

Children: Birth to 18 Years

Vision develops rapidly in the first years of life, and problems during this window can have permanent consequences if not caught early. A condition called amblyopia — commonly known as lazy eye — occurs when one eye does not develop normal vision, usually because of a misalignment (squint), a significant difference in prescription between the two eyes, or an obstruction such as a congenital cataract. Amblyopia is treatable in young children but becomes progressively harder to correct after age 7 to 8.

Children should have their eyes checked by a healthcare professional at birth and during routine paediatric assessments in the first two years. A comprehensive eye examination is recommended at age 3 to 4, before school entry. School-age children should have their vision checked every one to two years, with more frequent assessments if there is a family history of eye conditions, if they wear glasses, or if they show signs of visual difficulty such as squinting, sitting very close to screens, or struggling to read.

Young Adults: 18 to 39 Years

For healthy young adults with no known eye conditions, no family history of eye disease, and no systemic conditions like diabetes, a comprehensive eye examination every two to three years is generally sufficient. The primary purpose at this age is to establish a baseline, check for refractive error, and screen for early signs of conditions that may run in the family.

However, if you have diabetes, a strong family history of glaucoma or retinal disease, wear contact lenses, have had eye surgery, or notice any change in vision, more frequent examinations are appropriate. Contact lens wearers should be seen annually to assess the health of the cornea and ensure the lenses are fitting correctly.

Adults: 40 to 54 Years

The age of 40 is a critical inflection point in eye health. This is when the risk of glaucoma begins to rise significantly — doubling with each decade from this point. It is also when presbyopia begins — the normal age-related loss of near-focusing ability that sends most people reaching for reading glasses.

A comprehensive baseline eye examination at 40 is recommended for everyone, even those with no symptoms. From 40 to 54, examinations every one to two years are advisable, depending on risk factors. If you have a family history of glaucoma, are of African descent, have diabetes, or are highly myopic, annual examinations are appropriate from 40 onward.

Adults: 55 to 64 Years

Between 55 and 64, the risk of cataracts, glaucoma, macular degeneration, and diabetic eye disease all increase. Annual or biennial examinations are the standard recommendation. At this age, an eye examination is not just about checking your prescription — it is a health screening. The ophthalmologist is looking at the optic nerve for early glaucoma damage, scanning the macula for drusen or other signs of AMD, assessing the lens for cataract development, and examining the retinal blood vessels for signs of diabetic or hypertensive damage.

Adults: 65 Years and Over

From 65 onward, annual comprehensive eye examinations are recommended for everyone, without exception. The prevalence of cataracts, glaucoma, AMD, and diabetic retinopathy all peak in this age group. Multiple conditions often coexist — a patient may have early cataracts, mild glaucoma, and dry AMD simultaneously, each requiring monitoring on its own timeline.

Annual examinations at this stage are about active surveillance and early intervention. They allow the ophthalmologist to track changes over time using imaging tools like OCT and visual field testing, adjusting treatment plans as needed and intervening before vision is lost.

Special Circumstances: When You Should Be Seen More Often

Regardless of age, certain groups should have more frequent eye examinations:

• People with diabetes should have a dilated fundus examination annually — a non-negotiable recommendation from every major diabetes guideline.
• People with a family history of glaucoma should be screened regularly from age 35 to 40.
• Anyone on long-term corticosteroid medication needs regular IOP monitoring.
• People with a history of eye injury or surgery should follow their ophthalmologist’s recommended schedule.
• Anyone experiencing new or changing symptoms — blurred vision, flashes, floaters, distortion, pain, or redness — should be seen promptly, regardless of when their last examination was.

The Difference Between an Optometrist and an Ophthalmologist

Both play important roles in eye care. An optometrist is a primary eye care provider who performs eye examinations, prescribes glasses and contact lenses, and detects eye conditions. An ophthalmologist is a medical doctor who has completed additional years of specialist surgical training in diseases of the eye. Ophthalmologists diagnose and treat the full range of eye conditions, perform surgery, and manage complex or sight-threatening disease.

For routine vision checks and prescriptions, an optometrist is an excellent first port of call. For screening, diagnosis, or management of conditions like glaucoma, cataracts, diabetic eye disease, or macular degeneration, or for any surgical consideration, an ophthalmologist is the appropriate specialist.

About Dr Johann Snyman

Dr Johann Snyman is a specialist ophthalmologist practising in Kloof and Westville, Durban. He provides comprehensive eye examinations for all age groups, with particular expertise in cataract surgery, glaucoma management, diabetic eye screening, and macular disease. He holds the FCOphth from the Colleges of Medicine of South Africa and an MMed in Ophthalmology from UKZN.