Many doctors and parents have their own explanations about dilated eye examinations. Some patients think that dilated eye examinations are harmful to their eyes, some think that they must be dilated to be accurate, and some think that children under 12 years old are inaccurate if they do not use atropine to dilate their eyes.
Once in medical school, as a cradle for training future ophthalmologists, the school had the explanation that generally under the age of 12, refractive errors are dilated with atropine, and under the age of 12, rapid dilating medication (compound tropicamide) is used. When I got to work, I started to be confused, and different hospitals gave different criteria, some said that it was okay to use atropine for up to 8 years old, and fast dilating after 8 years old. Later, when the medium-acting pupil-dilating drug cypionate hydrochloride (Safije) was introduced on a large scale in China, many hospitals used this drug instead of atropine, and many hospitals still continued to use atropine or compound tropicamide, which was once used in textbooks. Should dilated pupils be used across the board as described in the books? There are many questions: Why do I need to dilate my pupils? Do I need to dilate every time I get an eye exam? Are they inaccurate if they are not dilated? Are dilated pupils only used to identify true and false myopia? Is astigmatism not necessary if there is only astigmatism but no myopia? Over the years of working in pediatric ophthalmology I have gotten some answers. Nowadays, computerized optometry is very powerful in correcting myopia, can I trust computerized optometry? Tang Yan, Ophthalmology, Beijing Aier Yingzhi Eye Hospital
One: Dilated pupils are an irreplaceable tool in refractive eye clinics.
What kind of people need dilated pupils? Let us first explain that the purpose of dilated pupils is to exclude the unreal results of refractive state caused by the adjustment of the crystal tension.
Examples.
1.Identifying true and false myopia: XX female 12 years old before dilated pupil: VOD 0.7, VOS 0.8 apparently optometry: R-0.75/-0.75*20–1.0L-0.75/-0.75*180–1.0, compound tropicamide after dilated:VOD1.0, Vos -/-0.50*180–1.0.
2.Children’s hyperopia optometry: Hu XX male 6 years old Before pupil dilatation: VOD 0.8, VOS 0.5. Computerized optometry: R-6.00/-6.50*165 Retest: -3.00L-2.00/-0.75*10 After dilatation with medium-acting dilatant:VOD+2.75–1.0Vos +5.00/+0.50*110–1.0.
3.Adult hyperopia optometry: Wang XX, female , 20 years old, VOD 1.0 VOS1.0, computerized optometry: R+0.75DS L+1.00DS. dilated optometry: R+5.00DS – 1.0 L+5.00DS – 1.0.
4. Astigmatism in children.
Wang XX Female 6 years old Kindergarten physical examination revealed poor visual acuity. Computerized optometry: R+1.50/-1.75*165, L+1.50/-2.75*10 Apparent optometry R–/+1.50*80–1.0-L+1.75/-2.25*180–0.8-Post-dilated optometry: R+4.25/+1.50*80–1.0, L+5.00/+2.50*95–0.8 Prescription How to give? If I believe in computerized optometry without dilated pupils can I?
5, treatment of patients with abnormal regulation: male 8 years old, vision loss for two weeks, check: VOD 0.2VOS.02 apparently optometry: OD, flat light – 0.2+ (PH not mentioned) OS flat light – 0.2- (PH not mentioned) consider fundus disease? IOP often, anterior segment (-) small pupil fundus (-) OCT? After treatment of dilated pupil: R+1.50/-0.50*180–1.0L+1.50/-0.75*180–1.0
One week after pupil dilatation: Vou sc: 1.0.
6.Strabismus-adjusted internal strabismus: XX female 1.5 years old with bilateral internal strabismus for 3 months came to the clinic for examination: alternate eye position gaze +15° 1% atropine dilated for three days for examination: eye position orthoptic shadow: OU+6.00DS
7, strabismus – intermittent exotropia: XX female 25 years old Complaint: since childhood eye strabismus examination: eye position positive, alternating masking immobile synoptic machine examination: eye position positive? No strabismus?
Look away from the cover for 3 minutes to open the moment: eye position -30 ° adjustment amplitude: -7.00 DS adjustable convergence control exotropia amount, trigeminal examination can not cooperate. Check after dilated pupil: Exotropia -60 prism degrees. (far=near)
8, adult highly refractive error optometry: Jia xx male, 30 years old, monocular vision loss to the clinic, before dilated pupil right eye -8.00/-1.00 * 90-0.7 (visual instability), consider ophthalmology? Do OCT examination? Right eye after dilatation: -7.50/-1.00*90-1.0. (Late visual acuity stable) Follow up with medical history, continuous electronic reading history for the past month.
There are many other examples of dilated eye examinations that can effectively guide our prescriptions and give us the reasons for the patient’s vision loss, helping us to treat the patient, but must all patients have dilated eye examinations? Must we use age as a blanket rule? The answer must be no.
There are several methods that can help us effectively verify the accuracy of optometry and whether dilated pupils are needed.
1, visual acuity: best understood, our patients have a good and stable distance and near vision, in line with the laws of age can be verified
2, visual function: in clinical optometry we will add NRA/PRA, BCC, etc. to verify whether the patient’s adjustment can be fully relaxed, to give a few examples: for example, the normal value of NRA is +2.25 – +2.50, if our patient examination NRA value is much higher than this number, such as +3.50, it is likely that we give the prescription myopia is overcorrected state, or farsighted undercorrected state. or an undercorrected state of hyperopia. If the NRA result is +1.50, the patient’s eyes are not sufficiently relaxed, and although the prescription is not necessarily problematic, the patient’s adjustment spasm must be treated by dilating the pupil.
3, check shadow optometry: in time we used the best computerized optometry, the accuracy of the capture is hardly more than 80%, a qualified optometrist’s check shadow optometry can increase this accuracy to 90%, we have a lot of children, in fact, just screening vision, poor vision, computerized optometry shows for myopia, through our optometrist’s check shadow optometry, without dilating the pupil can determine that part of the child is actually normal The, or mild hyperopia, do not need to use 21 days to recover atropine on the child for optometry.
4, fog optometry: as a means to help us optometry, comprehensive optometry steps include fog optometry this step, can largely reduce the original direct insertion of the film led to myopia overcorrection. There is a child and adult can avoid dilated optometry.
5, eye axis examination: currently can be non-contact non-invasive means to check the child’s eye axis, as a patient refraction out of focus degree of judgment has a very strong guiding significance.
There are many ways to help us optometry, optometry is not lost as an art, since it can be roughly generalized examples. Back to the question of whether there is a one-size-fits-all approach.
First of all, the process of optometry is an individualized process, and it is very incorrect to have a one-size-fits-all approach to either age or the choice of dilating medication. For a child with a positive eye position, simple astigmatism, and no amblyopia, it is not necessary to use 21 days of atropine for the child’s optometry. For a child with stable and unchanged refractive error, it is not necessary to clarify the child’s refractive status with a dilated eye exam. For children under 12 years of age with myopia, especially children with exotropia, a medium-acting dilator can completely replace atropine. In some children, as young as 5 years old, we suspect pseudomyopia, and sometimes a single drop of fast-dispersing medicine can give a satisfactory answer, and the child saves the discomfort of 21 days of atropine dilated pupils.
Here I would like to conclude that dilated pupil testing, as a routine means of refractive examination, is not harmful to the eyes as parents believe, and that current research results show that a proportion of children can control the development of myopia with long-term low concentrations of atropine dilated medication, and that the effectiveness is of great significance. But there is no need for a one-size-fits-all approach to optometry, and experience and individualization are very important in the workplace.
Specific cases will continue to be provided in the next issue.
This article is published with permission from Dr. Tang Yan.