Invest in your Eyes?
Surveys often ask people to list some of things they fear the most in their lifetimes. One of the common answers is going blind. However, there is often a huge disconnect on what people say and what they actually practice. They value their eyes the most, so they say, but then make bad decisions when it comes to their eyes. For instance, contact lens wearers don't change out their contacts as often as they should. Some are just lazy and some just don't want to spend on buying more contacts. Sometimes we recommend special tests to rule out glaucoma or other eye conditions, yet patients instead sign a form saying they refuse the test. We have found most of these refuse for cost reasons despite the cost being very reasonable. A final example is patient's want lighter and thinner eyeglasses and want to get the best vision possible,, but instead buy the cheapest lenses available. So why the big disconnect? These same patients often drive the nicest cars, have the latest and greatest cell phone and data plan to match, go out to eat every weekend, have no problems buying cigarettes or alcohol or lottery tickets, spend top dollar on cosmetics, nails, hair styles, etc. The point? How much do you truly value your eyes? Would you rather buy a box of daily disposables contacts for $65 (3 months supply) or would you rather spend $150-$200 per month on your cell phone? Would you rather have an $600 or more car payment for month (that's nearly $15,000 over 2 years) or would you rather spend $250 on a nice pair of Oakleys or RayBans that will typically last you 2 years? Society deceives you and makes you think other things in life are more important. Are they? Invest in your eyes? Only you can decide.
At Alice Family Eye Center, we routinely dilate all patients that allow us to do so. It is certainly the patient's right to refuse dilation, so we kindly ask all patients before. Dilation is an integral part of an exam. A dilated eye exam gives YOU, the patient, a better exam by allowing the doctor to get a better view into the back of your eyes. This helps the doctor check your eyes better for cataracts, glaucoma, retinal disorders and other diseases of the eyes. We dilate all children because a prescription is rarely correct in children unless a "wet" or dilated refraction is performed.
Recently, a few patients have come into our office stating another office is offering exams without dilation. It is unknown whether patients are misinterpreting this information or if they are being told dilation is not necessary. Please let me be clear. All patients should be dilated!! If you are told dilation is not required, I suggest you walk out of that office and seek another provider. Dilation is the standard of care and should be performed whenever possible. There are some contraindications for dilation, so please discuss any concerns with your doctor as a few patients should not be dilated.
That said, there is an amazing device on the market by a company called OPTOS. This machine is awesome and is great technology. It does allow a very good retinal exam to be performed without the need for dilation. That is certainly true. But does that mean dilation should not be performed?
ABSOLUTELY NOT!!!! Although dilation is up to the patient and the doctor, the doctor is required to look in the back of your eyes with retinal lenses whether dilated or not. This is a requirement by the Texas Optometry Board. The Optos device often will provide an excellent view of the entire retina, but it should be used in conjunction with dilation to provide the best possible exam and should never be a substitute for a retinal exam by your doctor. This device performs a very thorough exam of the entire retina. It is essentially a camera. Unlike other imaging devices, it is not an ultrasound and does not look at the internal retinal like a Cirrus OCT, which shows the deep layers of the retina. The disadvantage of the retinal ultrasound, however, is that it is primarily for the central retina. The OPTOS does an amazing job in the periphery, but does not look deep at the retinal tissue and does not analyze the nerve fiber layer for early glaucoma detection.
So again, the OPTOS device is awesome. If you go elsewhere, I highly recommend you have an OPTOS scan WITH dilation. If you can't get your eyes dilated because of a contraindication, the OPTOS is still btter than an exam without dilation. In addition, if you can get a retinal ultrasound and central retinal photos, you are being served incredibly well and are getting an awesome retinal evaluation.
At Alice Family Eye Center, we have chosen not to utilize this technology yet. We have instead invested in a Cirrus OCT for central retinal defects. Both these devices cost well over $70,000 and so is often cost prohibitive to have both. These tests must be billed to the patient and so patients rarely want to pay for 2 value added tests. While we would love to have both devices, we chose the OCT as this helps in the diagnosis of more complex and sight threatening defects such as diabetic retinopathy and edema, macular disease and glaucoma.
So if you go elsewhere, get your eyes dilated and get the OPTOS scan if possible. If you come to our office, get your eyes dilated, get the CIRRUS OCT, get the GDXvcc, and get retinal photos.
Finally, below is an excerpt from the Texas Optometry Board newsletter informing doctors of their requirement to perform a retinal exam on every patient.
TEXAS OPTOMETRY BOARD NEWSLETTER 2009
In a concerted effort to be pro-active, the
board wishes to direct your attention to the
Board Rules concerning an internal ophthalmo-
scopic exam and digital imaging instruments.
Board Rules 279.1 and 279.3 specifically require
the use of an ophthalmoscope or biomicroscope
with fundus condensing lenses to perform the
internal ophthalmoscopic exam, a required ele-
ment of an eye examination. “Videos and pho-
tographs may be used only for documentation
and consultation.” Such videos and photographs
(including digital imaging) are not substitutions
for an ophthalmoscopic or biomicroscopic exam
of the fundus. Performing only digital imaging
will not meet the requirements set by Rules
279.1 and 279.3.
Thank you to all our patients who have had very kind things to say about our new office. Although not perfect, we are very happy with the final outcome. We truly believe Alice now has one of the premier optometry offices in the entire area, maybe even the state. Our patients deserve the best and we can only hope they appreciate the effort. This project was in the planning stages for a few years and we hired an out of state company specializing in eye care to help with the interior design and to put it all together. We now have 5 exam rooms to better serve you and have 2 pretesting rooms to move patients efficiently through the office. So again thank you to all our patients for your continued support. This project would not have been possible without our loyal patients and their support over the years. Thank You Alice and Surroundings Areas!