Bill Harvey: Width of a circle
Author: Bill Harvey
Hand on heart – are you really able to check the health of a patient aged over 65 years without dilating?
It’s that time of year when my mom goes for her annual check. Blessed as she is with small pupils and lens opacities, I can vouch that an adequate view of her retina is not possible undilated. Yet, each year she manages to have a paid-for eye check and ‘those horrible drops you make me have William’ are successfully evaded. Bar moving her to Scotland (tempting sometimes) or seeing her myself, how is this allowed?
And it is not just the elderly. Optician has previously published case studies where pathology in a younger patient may have been missed had they not undergone a wide-field scanning laser ophthalmoscopy assessment. One example that springs to mind included the detection of a malignant melanoma in the periphery of a pale patient of Celtic extraction that could easily have been missed without dilation. Consideration of risk factors here might have prompted a dilation otherwise ruled out in a younger asymptomatic patient. We have also run a series on detachment which clearly stated that you cannot record ‘no Shafer’s sign’ unless having first dilated.
Section A44d of the College of Optometrists guidance, under the heading ‘Conducting the routine eye examination’ clearly states ‘If you cannot obtain an adequate view of the fundus you should dilate the patient’s pupils.’
So, is the challenge due to a combination of time and funding? Let’s stand up to those wishing to limit testing times for non-clinical reasons. And let’s kick up more of a stink for adequate funding of ‘supplementary testing’ when they are no longer ‘supplementary’ as with the elderly.
A great review of the retinal periphery by Quinn et al in this month’s Progress in Retinal and Eye Research, has just been made available as a free download. Highly recommended.