Last one done was my granddaughter. The eye exam was done at an America's Best shop (I got the twofer special for her).
My wife is a retired opthalmic tech and she knows more about this than I do. GD was dilated, the tech checked the pressure, and took the photos of the retina and optic nerve, and did an auto refraction.
GD then had a zoom(?) meeting with an optometrist. The tech put the readings from the auto refraction into a foreopter and the optom had GD look through it, while he did the "better or worse" dance. IIRC, the foreopter had a wire running into it, because the optom was controlling lens selection remotely.
The optometrist reviewed the photos, signed off no noted problems and cut the script electronically.