DILATION Ideally a teleophthalmology program is run without the need to dilate patients. However, in certain situations (such as photographing older patients, the inability to dilate, or a patient with genetically smaller pupils), image quality will be enhanced if a patient’s eyes are dilated. Before beginning to dilate patients, clinics should assure that their liability insurance covers dilation and the patient is properly informed of the risk factors.​ EXAMPLE DILATION PROTOCOL​ If patient is difficult to photograph (i.e. due to patient or camera operation challenges), ask the following:​ 1. Have you ever had your eyes dilated? 2. Did you have any complications?​ 3. Have you ever been told that you have a type of glaucoma called acute angle closure? If so, did you experience eye pain, redness or blurred vision after dilation? If NO to questions 2 or 3 above – proceed: Educate patient about the risks of dilation and request the patient’s signature on a consent to dilate form.​ Risks to dilating the eyes: 1. Blurred vision 2. Light sensitivity​ 3. Burning sensation upon installation of dilation drops Dilate patient using a trained clinic staff.​ Dilation training video can be viewed at www.auch.org. Recommended medications: • 1% tropicamide​ (Note: Patient who has had diabetes for less than 10 years, over 10 years with poor diabetes control) • 2.5% phenylepherine. (Note: The risk of angle-closure with dilating drops is 1:20,000 if both tropicamide and phenylepherine are used. The risk of using tropicamide alone is almost 0.)​ ​Document, on the Retinal Screening Form, that the patient’s eyes were dilated.​ Notation for charts:​ T 1 OU = Tropicamide for both eyes T 1 OD = Tropicamide, right eye only T 1 OS = Tropicamide, left eye only​ Wait 10-15 minutes and re-photograph dilated patient.​ ​ istribute dark glasses and assist patient to determine if it safe for them to drive. (Note: Only the patient should D determine whether they feel safe to drive after dilation. Driving is an option for many patients with sunglasses, but a clinic staff member should not make that determination if dilated patient is able to drive.)​
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