The metaphysics of dilation

The metaphysics of dilation 0

Because I am an optometrist I dilate. Or is it because I dilate I am therefore an optometrist? In either case I am allowed, by law in Colorado, to use diagnostic pharmaceutical agents in the course of a patient examination in order to enlarge pupils. I’ve recently come to find out that there’s a wide range of the use of these drugs by others in my profession. My debate over the purpose of routine use of these diagnostics was made clear to me after 16 pages of discussion but ended more in how often a patient should be seen for a regular eye exam than how often a patient should be dilated.

First, the drugs. Dilating can be done with different chemicals. There are kinds that vaguely dilate pupils and others that can maximally dilate your pupils for a week or more. Why would one doctor use one drop and another doctor choose the stronger or weaker one? That, my friends, is based on your doctors training and beliefs or needs. You see, doctors are people. There isn’t one way to do things so we pick the way we personally want it done. And that’s ok. Here are a few types of dilating drops if you want to look them up: tropicamide, paremyd, phenylephrine (also found in some OTC redness relievers), homatropine, cyclopentolate and atropine. And most of those drugs can be in different strengths (ex., 0.5%, 1%, 2.5%, 5%, 10%).

In the 16 pages of discussion I finally got to the bottom line of when to dilate a healthy person with very low or no prescription who has no complaints or known medical conditions leading to eye disease. It would be done in their next recommended visit…..in 5-10 years! See the link below if you want to read the guideline. That lengthy period was an eye opener. Honestly, telling a patient to come back in 5 – 10 years basically sounds like we don’t want to see them again. But that’s what the guideline says. My own profession’s main association (American Optometric Association, AOA) says eye exams are recommended every 1-3 years for the same healthy individuals. That’s a conflict right there. There’s something even stranger about this. These vision plans that I accept, many times they allow an eye exam every year. There’s an incentive for everyone involved to possibly over-utilize health care here. And why not? Don’t companies want you to use things more often because they will make more money? That’s the American way.

Why dilate anyway? The main reason is an attempt to see the various “parts” of the back of the eye. We have to look through the pupils to do that, to see the retina, and the bigger the pupil opening the easier it is to see back there. It’s like peering into a mystery world that is unknown until we spelunkers go check.

Before anyone jumps to conclusions about what their eye doctor does or doesn’t do, you should be in good hands. This post isn’t about covering all the reasons for dilating either. Each doctor has their own routine for your routine eye exam. Just remember to tell them of anything you can recall about your eyes and vision. That will make it easier for your doctor to decide whether they may or may not dilate you. And just an interesting note about eye (iris) color….blue eyes generally dilate with less drugs than brown eyes and the length of dilation for blue eyes is also generally shorter but the same drop might work as well on both eye colors.


dilated vs undilated

dilated vs undilated


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Free contact lenses

Free contact lenses 0

I hope my optometrist friends don’t get upset but many of you that wear contact lenses might know this anyway. My office, and I’m gonna guess every other eye care office, gets free contact lenses from their distributor. What is interesting is how we decide which contact lens to give you. I don’t think there’s anything exceptionally rational medically about how we go about doing this. You get what we give you and once we write the prescription that’s all you get.

Before I go any further, when I say free contact lenses, I should also say that you will have to pay for the exam for them. The lenses themselves should be free to try for most of you. There are some specialty lenses but probably most patients wear the regular ‘ol disposable lenses that I and other optometrists get free.

Here’s how to get even more free contact lenses. At your next eye exam tell your eye doctor that you would like to try a couple of different brands to see how they feel. There’s nothing wrong with that straight up question. You might even tell the optometrist that there’s nothing wrong with your brand. You’re only interested in knowing if the comfort or vision is any different from your current brand. Ask for some daily disposables too. Those generally come in 5 packs so you get 5 days of wear with them. These are handy for when you’re camping or on a vacation.

If you wear lenses for astigmatism your eye doctor might need to order those trials but they should still be free. Because the combinations of powers that have correction for astigmatism would require a huge quantity of trials (not enough room for all that) you might have to wait to get those. There’s also nothing wrong to ask for lenses that might not correct your astigmatism either. If you have a mild amount of astigmatism you possibly would see about the same as spherical contact lenses that aren’t specifically made to correct astigmatism.

And, please, if you ask for a couple of different brands, do support the eye doctor who gave them to you and buy a supply from them. We are here to try and help. I’m just giving you an extra tip to help yourself a little. I hope you are a good patient and hope your eye doctor will honor your request. It may not be something they believe in doing so that’s up to their practice. I would think this a very reasonable request in my office.

If your contact lenses are the kind that don’t come free to the optometrists, I’m sorry about that. Ask for some extra trial boxes of contact lens solution then. That’s also free!

Good luck with that and would you let me know how it worked out if you do get some extra pairs?

free contact lenses

free contact lenses


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