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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
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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.
Distribute dark glasses and assist patient to determine if it safe for them to drive. (Note: Only the patient should 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.)
