Is pupil dilation still really needed during eye exams?

Q: My husband, who is diabetic, just had his annual eye exam and his doctor insisted on dilating his pupils. My eye doctor is using a new instrument to see inside my eyes without those drops. Which is better?

A: We are often asked about this in our clinic also, but generally for diabetic patients we still prefer to use pupil-dilating eyedrops. This recommendation is true whether the patient is already on diabetic medications, has been told they are “borderline” or “pre-diabetic.” In fact, for all these stages of diabetes, our primary concern is the accurate diagnosis of changes in tiny blood vessels inside your eyes. With enlarged pupils, we are able to better examine those retinal capillaries for early signs of damage or leakage. This condition is called diabetic retinopathy, and is essential for medically controlling the common eye effects of diabetes.

Furthermore, most medical insurances are now recommending, or requiring, dilated eye exams for diabetic patients each year. In fact, your family doctor or internist, is generally seeking assurance every year that your eye doctor has carefully examined the retinal with dilation. A few insurances now waive your co-pay for dilation, as an added encouragement for diabetics to have this procedure annually.

You are correct also in that we are using new instruments to obtain images of the retina without dilation. In fact, for most non-diabetic patients we offer a choice of techniques. The newest imaging technology provides us a very clear and very wide view inside the eye. This overview of the retina is an excellent beginning point for most patients. Generally, if we see no areas of concern in this overview and the patient history is healthy, we would not insist on dilation. Most patients like this approach, as they have no enlarged pupils causing light sensitivity afterwards. And more importantly, they have no blurry vision afterwards to interfere with work and reading.

These new imaging procedures are generally not covered by medical insurance, so they are charged as “out of pocket” costs to the patient. Dilation procedures are generally “covered” by insurance, but with today’s high co-payments and deductibles, patients are commonly left with a substantial bill after their insurance processes their claim. Discuss these aspects with your eye doctor, or the insurance staff, to help decide which approach is best for you. Our goal is simple: To find any and all internal eye problems long before they affect your vision. You should never wait until your eyesight seems blurry, or until your eye(s) hurt. Your annual eye health exam, with internal retinal evaluation, is your best step to keeping good sight all your life.

DR. THOMAS STOUT, OD, FAAO is an eye physician in private practice at Morgantown Eye Associates. Info: MorgantownEye.com.

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