DILATING DURING EXAMS
Dilating pupils has been the standard of care for comprehensive eye exams for decades. Though “nothing can replace a dilated fundus exam by a highly educated optometrist,” many doctors in our survey cited Optos, Optovue and Eiden systems as alternatives. In cases where patients opted not to be dilated, some doctors felt confident in the use of these instruments. Although such improvements in imaging technology may be changing attitudes of clinicians, 50% of optometrists in our survey dilate patients in comprehensive eye exams. “While technology can allow for a tremendous view of the fundus, I don’t feel confident that technology can fully replace a dilated view of the fundus,” said one OD. So what do you do when your patient refuses dilation? See below.
What to do when a patient doesn’t want to be dilated.
“Refusal form needs to be signed, and we document refusal in chart. Strongly advise dilation for higher risk patients, such as those with diabetes, previous retina history, over 65, etc.”
“Fundus examination performed behind the slit lamp with off-axis 90D or digital widefield lens. Document that dilation was recommended and deferred by the patient.”
“We offer digital widefield imaging if they absolutely refuse to dilate. If there is something suspicious on the image, we will have them schedule for a full dilation.”
“Sign a form stating that I may not be able to detect retinal eye disease and cannot be held responsible.”
“They don’t get dilated and it is noted in their chart. Seldom happens.”
“I only see children. If they are new or hyperopic or high myopes I insist on the child coming back for dilation before committing to a prescription. If they are established and low myopes, I will perhaps skip a year of dilation.”
“Tell them that I wouldn’t skip it for myself or my family.”
“I give the analogy of taking a car to a mechanic for a thorough check-up and then telling him not to raise the hood. Works virtually every time.”
“If they were dilated the year before, I allow them to wait till the next year for their dilation. I dismiss patients who refuse dilation after hearing my explanation of why it is so important.”
“We tell them, “˜nobody likes to be dilated, but it is the only way I am able to view the inner structures of the eye properly to ensure everything is healthy. Now quit yapping and tilt your head back.'”