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Dilated fundus examination
Dilated fundus examination (DFE) is a diagnostic procedure that uses mydriatic eye drops to dilate or enlarge the pupil in order to obtain a better view of the fundus of the eye. Once the pupil is dilated, examiners use ophthalmoscopy to view the eye's interior, which makes it easier to assess the retina, optic nerve head, blood vessels, and other important features. DFE has been found to be a more effective method for evaluating eye health when compared to non-dilated examination, and is the best method of evaluating structures behind the iris. It is frequently performed by ophthalmologists and optometrists as part of an eye examination.
The most common agents used to dilate the pupil are phenylephrine (2.5% in pediatrics or 10% in adults) and tropicamide (0.5% or 1%). While phenylephrine stimulates receptors that contract the dilator muscle of the pupil, tropicamide blocks stimulation of the pupillary sphincter muscle to allow for relaxation. As the insertion of these drops may cause some stinging or burning, some practitioners choose to first insert a drop of topical anesthetic to numb the eye. Pupil dilation typically begins within 15 minutes and may last for 3–8 hours.
After the pupil has been dilated, an ophthalmoscope can be used to examine the fundus. This allows for 15x magnification of the optic disc, also known as the optic nerve head, and retina to better evaluate for any ophthalmic pathology. Evaluation of the optic disc may include noting the color of the disc, the sharpness of the disc outline and if any swelling is present, and signs of an enlarged or bulging optic cup, the central depression in the optic disc. Evaluation of the retina includes examining the arteries and veins for narrowing or arteriovenous nicking, as well as detecting any lesions, exudates, retinal hemorrhages, microaneurysms, or neovascularization.
Following a dilated fundus examination, patients may experience blurred vision and light sensitivity until the effects of the mydriatic eye drops wear off; for this reason, the use of sunglasses is recommended to prevent damage to the eyes while dilated.
The American Academy of Ophthalmology recommends comprehensive eye examinations, including dilated fundus examination, for asymptomatic patients without risk factors for eye disease at varying frequencies based on age: every 5–10 years in adults under 40 years, every 2–4 years in adults aged 40 to 54 years, every 1–3 years in adults aged 55 to 64 years, and every 1 to 2 years in adults aged 65 years and older. However, routine DFE is relatively low yield for asymptomatic patients.
In contrast, individuals with diabetes mellitus are at risk of diabetic retinopathy and therefore require more frequent screening. Those with type 1 diabetes should have their first comprehensive eye examination 5 years after diagnosis, followed by yearly exams. Those with type 2 diabetes should have their first comprehensive eye examination at the time of diagnosis, followed by yearly exams. Women with type 1 or type 2 diabetes who are planning a pregnancy should have a comprehensive eye examination prior to conception as well as early in the first trimester; women with gestational diabetes do not require screening for diabetic retinopathy during pregnancy.
For individuals at risk of developing glaucoma, the American Academy of Ophthalmology recommends screening every 2–5 years in adults under 40 years, every 1–3 years in adults aged 40 to 54 years, every 1–2 years in adults aged 55 to 64 years, and every 1 to 2 years in adults aged 65 years and older. Screenings may be recommended even more frequently for individuals of African or Hispanic/Latino descent, as these ethnic groups have a further increased risk of developing glaucoma.
A child's first vision screening is typically done shortly after birth during the newborn exam, during which a pediatrician will perform simple vision testing such as assessing pupillary response and a red reflex. However, if an infant is premature (gestational age under 32 weeks) or has a low birth weight (less than 1500 g) a dilated fundus examination is indicated due to risk of retinopathy of prematurity.
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Dilated fundus examination
Dilated fundus examination (DFE) is a diagnostic procedure that uses mydriatic eye drops to dilate or enlarge the pupil in order to obtain a better view of the fundus of the eye. Once the pupil is dilated, examiners use ophthalmoscopy to view the eye's interior, which makes it easier to assess the retina, optic nerve head, blood vessels, and other important features. DFE has been found to be a more effective method for evaluating eye health when compared to non-dilated examination, and is the best method of evaluating structures behind the iris. It is frequently performed by ophthalmologists and optometrists as part of an eye examination.
The most common agents used to dilate the pupil are phenylephrine (2.5% in pediatrics or 10% in adults) and tropicamide (0.5% or 1%). While phenylephrine stimulates receptors that contract the dilator muscle of the pupil, tropicamide blocks stimulation of the pupillary sphincter muscle to allow for relaxation. As the insertion of these drops may cause some stinging or burning, some practitioners choose to first insert a drop of topical anesthetic to numb the eye. Pupil dilation typically begins within 15 minutes and may last for 3–8 hours.
After the pupil has been dilated, an ophthalmoscope can be used to examine the fundus. This allows for 15x magnification of the optic disc, also known as the optic nerve head, and retina to better evaluate for any ophthalmic pathology. Evaluation of the optic disc may include noting the color of the disc, the sharpness of the disc outline and if any swelling is present, and signs of an enlarged or bulging optic cup, the central depression in the optic disc. Evaluation of the retina includes examining the arteries and veins for narrowing or arteriovenous nicking, as well as detecting any lesions, exudates, retinal hemorrhages, microaneurysms, or neovascularization.
Following a dilated fundus examination, patients may experience blurred vision and light sensitivity until the effects of the mydriatic eye drops wear off; for this reason, the use of sunglasses is recommended to prevent damage to the eyes while dilated.
The American Academy of Ophthalmology recommends comprehensive eye examinations, including dilated fundus examination, for asymptomatic patients without risk factors for eye disease at varying frequencies based on age: every 5–10 years in adults under 40 years, every 2–4 years in adults aged 40 to 54 years, every 1–3 years in adults aged 55 to 64 years, and every 1 to 2 years in adults aged 65 years and older. However, routine DFE is relatively low yield for asymptomatic patients.
In contrast, individuals with diabetes mellitus are at risk of diabetic retinopathy and therefore require more frequent screening. Those with type 1 diabetes should have their first comprehensive eye examination 5 years after diagnosis, followed by yearly exams. Those with type 2 diabetes should have their first comprehensive eye examination at the time of diagnosis, followed by yearly exams. Women with type 1 or type 2 diabetes who are planning a pregnancy should have a comprehensive eye examination prior to conception as well as early in the first trimester; women with gestational diabetes do not require screening for diabetic retinopathy during pregnancy.
For individuals at risk of developing glaucoma, the American Academy of Ophthalmology recommends screening every 2–5 years in adults under 40 years, every 1–3 years in adults aged 40 to 54 years, every 1–2 years in adults aged 55 to 64 years, and every 1 to 2 years in adults aged 65 years and older. Screenings may be recommended even more frequently for individuals of African or Hispanic/Latino descent, as these ethnic groups have a further increased risk of developing glaucoma.
A child's first vision screening is typically done shortly after birth during the newborn exam, during which a pediatrician will perform simple vision testing such as assessing pupillary response and a red reflex. However, if an infant is premature (gestational age under 32 weeks) or has a low birth weight (less than 1500 g) a dilated fundus examination is indicated due to risk of retinopathy of prematurity.