The metaphysics of dilation

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… 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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