…well, maybe.
A dilated fundus examination (DFE) remains the standard of care for the detection, management and treatment of retinal disease. Although this can often times be inconvenient, uncomfortable and laborious it still remains as one of the most traditional methods for the examination of the back of the eye. Things have changed but it took a number of years to get there. I remember my first encounter with an instrument that claimed to be able to negate the need for a dilation, I was an intern in my final year of optometry school. I don’t want to date or age myself but that was in 2001 and that instrumentation has improved (17 years later) but it still produces an image like the one below:
This image has always bothered me because it is not how the back of the eye appears. There is no green whatsoever in the physical examination of the retina. Even the diagrams/cartoons we study in textbooks and are easily searched on the internet to show no green and those lashes at the bottom could sometimes hide a valuable finding:
So, the question has always lingered, what is that prior image representing? Is it a true representation of the retina or simply a shortcut to see more patients by not having to wait to dilate the patients? While charging patients for an image that may not be truly representative of how the eye appears for the sake of convienence?
I am not here to judge what others do. I am here to justify why Gee Eye Care has finally now decided to employ the use of ultra wide-field (UWF) imaging and what I have decided to do. First off, an undilated view of the retina with traditional methods (ie. direct ophthalmoscopy, slit lamp with an auxiliary lens like a superfield or digital wide field lens) usually only yields, at maximum, a field of view of 30-60 degrees. A dilated view or a traditional image with dilation may yield a view at 100 degrees or more (depending on skill level). An image very similar to the one below:
The time has come where we can now produce an image to at least 200 degrees in true color! I have been waiting on this day since 2001. Some have questioned why I still dilated eyes at Gee Eye Care. Truth be told, I was not comfortable with any other technology that would properly be able to replace a dilated view with my own eyes and I was not going to compromise your eye health for a shortcut. Now I finally can show you why because we didn’t have the technology to show you before and you just had to take my word for it! I now feel confident in the image I am able to obtain in order to reliably depict the actual retina. It took some time and yes, further investment but I am so excited to present to you the following images taken by me on an undilated patient:
Taken with the Clarus 500 by Zeiss (https://www.zeiss.com/meditec/int/products/ophthalmology-optometry/retina/diagnostics/fundus-imaging/clarus-500.html)
Starting on October 8th we will be presenting patients with the opportunity to defer dilation and choose this imaging. However, some patients will be required to be dilated:
- all new patients
- children (in order to best determine refractive error changes)
- certain patients with known or suspected disease that may affect the retina (to name a few):
- diabetes
- hypertension
- acute peripheral retinal degeneration
- certain patients at Dr. Gee’s discretion
This imaging is available to all, even if dilated, for documentation purposes. When appropriate, it may be billed to your insurance but the cost will be $30 out of pocket for both eyes. This option will be presented to you before the examination and you will be given the choice to choose prior to beginning your examination (note, Dr. Gee may need to still dilate your pupils if something is noticed upon obtaining the image). These images will be reviewed by Dr. Gee and shared with you during the examination. If you would like them digitally sent to you, please ask and they will be emailed immediately.
Welcome to the new age of eye care. Dr. Gee and Gee Eye Care has always been proud of being on the forefront of eye care technology and this is no different!
Click here to set up your appointment for the “no puff,” “non-dilated,” “no 1’s or 2’s” eye and health examination!
#SiennaEyeDoc
https://www.mayoclinic.org/tests-procedures/eye-exam/expert-answers/eye-dilation/faq-20057882
Notes:
- Image #1: reference and link to OptoMap Daytona, taken directly from their website
- Image #2: diagram taken from Cirrus OCT poster
- Image #3: photo captured by Dr. Gee
- Images #4 & #5: photo captured by Dr. Gee on an undilated patient
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