FROM THE EDITOR:
As often as the sun rises and sets, there will always be a frank and open discussion of the dilated eye examination. For many, it is a “line-in-the-sand” where a patient could be denied care if the patient does not consent to dilation. It is the last bastion of control of their own work and strikes at the heart at what it means to be a professional.
On the other hand, a growing sense of engagement within patients who want to participate in their own care is also a factor. In many kinds of medical care, a patient is informed
for procedures which can affect their physical performance or well-being. If a dilated eye examination is classified in the same vein as this, should permission be requested
before dilation is performed.
Still more controversial is the refusal of care should dilation be refused. Should doctors refuse eye care in this case? Fortunately, eye care is rarely an acute medical problem and such decisions of delayed care can be safely done without detriment to a patient. But the question remains whether such refusal is a badge of honor or poor business practice.
The arguement in support of dilation is even codified in some state practice laws. In those cases, to qualify for a “comprehensive eye examination” a patient must be dilated. Curiously, these laws do not mandate dilation for all patient clinical encounters, only those being characterized by the doctor as a comprehensive examination.
Much of this discussion is not new but has been highlighted recently by the social trend of the patient being able to participate in their own medical care. As health professionals, this clashes with their sense of duty where no matter how informed a patient is, the actual severity of an eye condition or the importance of a procedure is still rests with the health profession.
In summary, the arguements will continue and it is likely that each doctor will have their own standards of behavior. Let us not judge these doctors as less professional. I don’t believe that any single procedure is an absolute badge of professionalism. In the end, if the patient is served by their own level of professionalism and there is no severe sequelae, they have done their job for the patient as well as anyone else.
Citation: Park HY, Park SH, Oh YS, Park CK.Nail bed hemorrhage: a clinical marker of optic disc hemorrhage in patients with glaucoma. Arch Ophthalmol. 2011 Oct;129(10):1299-304.
Overview: Considering finger and nail bed vascular changes are associated with diabetes and hypertension, this paper seeks to apply a similar biomarker or proxy for the presence of glaucoma. However, like diabetes, the association with glaucoma to nail bed vascularization is not completely specific or sensitive, but there remains a strong association which I believe might be clarified with additional research.
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