Dilated eye exams still give widest view into eye issues

A Sanford Health optometrist shares what you didn't know about dilation

Dilated eye exams still give widest view into eye issues

Typically, people see their optometrist just once a year. Yet they rely on their eyes nearly every waking moment.

That’s a good reason to make sure their appointment covers every aspect of their eye health. So in addition to having vision problems corrected, they want to know their optometrist is hunting for any signs of serious conditions or disease, especially as they age.

Optometrists such as Sanford Health’s Christopher Kelly, O.D., look for issues including retinal tears, diabetic and high blood pressure changes, cataracts, macular degeneration, glaucoma and masses such as ocular melanoma.

And even though it’s been around for 50 years, the dilated eye exam still prevails as the best way to view as much of the eye as possible. Dr. Kelly said that on a hypothetical perfect patient, dilation allows an optometrist to see 240 degrees of the eye, compared to a popular imaging technology, Optomap, that can show only 200 degrees in an image.

Dr. Christopher Kelly headshot
Dr. Christopher Kelly

Dr. Kelly stresses the importance of dilation. “It’s the only way to see out in the far periphery of the back of the eye,” he said.

“There’s been plenty of times that, had we not done a really good dilation, I definitely would have missed one of those little tears, and that could eventually develop into a retinal detachment.”

If you’ve been avoiding the unknown, here are some key things to keep in mind about dilation.

Dilation isn’t just for older people.

While some eye diseases do become more common as people age, dilated eye exams can catch conditions in people of any age. Dr. Kelly has had young patients unaware that they had eye inflammations or small retinal tears until he found them during a dilated exam.

Driving is possible after dilation.

Most patients can drive themselves away after their dilated eye exam, Dr. Kelly said, depending on their comfort level. He provides darkened dilation glasses to protect the sensitive dilated pupils.

People who are photosensitive may prefer to bring a driver, as well as people who are having a dilated exam for the first time.

Dilation drops vary in strength.

Dr. Kelly uses mild drops and stronger drops to help dilate the eyes. The mild drops open the pupil, he said, but don’t really cause side effects in people. The stronger drops open the pupil wider, so in addition to light sensitivity, they tend to cause vision to blur a bit, including near vision, for two to six hours. Still, he finds that this combination of two drops causes less severe side effects for the patient than using a much stronger single drop, which some optometrists prefer.

Younger, healthy people may be able to get by every other year with just the mild drops, which allow Dr. Kelly to see about 200 degrees of the eye. But he typically uses the stronger drops on patients in their 50s and older every year.

The dilation part just takes a few minutes.

Once a patient’s eyes are dilated, Dr. Kelly wears an indirect ophthalmoscope on his head containing binocular lenses with mirrors and a light, and he holds a lens in his hand, to view various angles of the patient’s eye. Dr. Kelly estimates that this part of an exam takes roughly three to five minutes, depending on the patient.

Dilation would be pretty tough to replace.

Dr. Kelly doesn’t foresee any new technology in the near future that could replace dilation’s wide view.

“It’d be pretty hard with a machine to look through the pupil to get the image,” he said, unless it could be manually maneuvered around.

If he finds a concern, he does have other instruments that can scan the back of the eye to show more specifically depth, cross-sections and fluid.

Make the most of your exam.

Try to come into your appointment well-rested, Dr. Kelly recommends.

If your eyes are dry and you wear contacts, it might be best to wear glasses to the appointment instead.

And don’t be deterred by dilation. “It doesn’t last forever, it just lasts that part of the day,” Dr. Kelly said. “And to look out at the retina and see those things, it’s just important.”

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