4 ms·

"unnecessary pupillary dilations and air puff tests (which by the way are wildly inaccurate,) " How true is this ? I am not refuting this as I have no credenti

"unnecessary pupillary dilations and air puff tests (which by the way are wildly inaccurate,) " How true is this ? I am not refuting this as I have no credentials in this space but as someone who is very near sighted, I depend on these exams to make me feel safe and I do them once every year as the doctors have suggested over the years. It is scary to know that they are wildly inaccurate.

Killakwinn 5y ago
Good question. These statement applies to patients who have no to very minor eye issues, meaning healthy people under age 40 who have refractive errors of ~1D (ideally less,) who have never been diagnosed with eye disease, who have no family history of eye disease, and who have good vision (that they are happy with.) It sounds like you probably have a refractive error of >6D, in which case yearly dilated exams are good practice. Re: inaccuracies, what I am referring to is the air puff test. The air puff test is a very crude measurement of eye pressure (aka intraocular pressure, or IOP.) The gold standard is Goldman Applanation, which involves putting yellow fluorescein drops in your eye and then using the applanation tip and a blue light to assess IOP. More on Goldman Applanation here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206330/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206330/ Hope this helps!
542458 5y ago
I strongly object to these statements. Dialation may not be necessary every single time for a healthy adult, but it’s good to do occasionally as there are serious diseases that can only realistically be checked by getting a good look at the back of the eye. Puff test can be vision-saving. It takes almost no effort, and is an excellent screen for glaucoma. Glaucoma is irreversible, and catching it early is essential to saving your vision. It’s not as accurate as other measures, but it’s fast (they’re usually doing other tests simultaneously) and easy so why not do it? But if you want the extra accuracy you can ask for the applanation - any decent optometrist will do it for you if you want. Some people prefer it.
- Killakwinn 5y ago
  I understand why these statements might seem extreme. A few points here: 1) I don't believe I've stated that dilated eye exams should never be done. One of the biggest reasons remote eyecare is relatively far behind compared to other specialties (remote dermatology, for example) is the need to visualize the retina up to the ora, where a lot of pathology (e.g. retinal holes) can hide. Currently, the only ways to visualize the retina this comprehensively are a) scleral depressed dilated eye exams and b) use of wide retinal imaging (e.g. Optos.) Theoretically, "a" can be done in the home via an "on-call" ophthalmologist or optometrist and "b" can be done via an eye van (ZSFG actually has this option,) but neither of these can scale very well. So we're working on a scalable solution that will enable the collection of data on par with what can be gathered via a traditional dilated eye exam. 2) My 2 cents re: cost-saving and efficient glaucoma screening methods is that we need portable IOP measurement devices. Since we're currently limited by existing technology, my vote is for a using tonopen (portable, affordable, accurate) over non-contact tonometry (nonportable, expensive, not accurate) when it comes to rapid remote screening.
  - cik 5y ago
    I'm not an American, but I've had eye tests in both Canada and Israel. Just how expensive are these? In Canada they're free - covered by health care (Glaucoma). Regular eye tests in Canada cost ~$49 (clearly, Queen Street). In Israel they cost 22 NIS, about $6.
    - Killakwinn 5y ago
      That is INCREDIBLE. When someone is paying for a full eye exam out of pocket in the US, it can cost anywhere from $69 to $150 USD.
      - cik 5y ago
        For something that's preventative? Why would it cost a lot for preventative treatment that reduces overall health care spending?
alex-lx 5y ago
Because I was diagnosed with glaucoma, I do an air puff test per month to monitor my eye pressure. I'm not sure how inaccurate it is, but it still a very useful method, which is easy to run and unharmful
- Killakwinn 5y ago
  There are very few instances in which a patient with chronic glaucoma needs monthly IOP checks (vs someone who came into clinic with an acute event and goes on to need emergent surgery.) And in those cases where monthly IOP checks are needed, it is definitely not gold standard to use the air puff test. I'd say that measuring IOP every 3-4 months is a typical regimen for a patient with more advanced glaucoma; these measurements should always be done via the same method (Goldman applanation) at the same time of day (due to AM to PM fluctuations in IOP) to be the most accurate.

Killakwinn 5y ago

Good question. These statement applies to patients who have no to very minor eye issues, meaning healthy people under age 40 who have refractive errors of ~1D (ideally less,) who have never been diagnosed with eye disease, who have no family history of eye disease, and who have good vision (that they are happy with.) It sounds like you probably have a refractive error of >6D, in which case yearly dilated exams are good practice. Re: inaccuracies, what I am referring to is the air puff test. The air puff test is a very crude measurement of eye pressure (aka intraocular pressure, or IOP.) The gold standard is Goldman Applanation, which involves putting yellow fluorescein drops in your eye and then using the applanation tip and a blue light to assess IOP. More on Goldman Applanation here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206330/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206330/ Hope this helps!

542458 5y ago

I strongly object to these statements. Dialation may not be necessary every single time for a healthy adult, but it’s good to do occasionally as there are serious diseases that can only realistically be checked by getting a good look at the back of the eye. Puff test can be vision-saving. It takes almost no effort, and is an excellent screen for glaucoma. Glaucoma is irreversible, and catching it early is essential to saving your vision. It’s not as accurate as other measures, but it’s fast (they’re usually doing other tests simultaneously) and easy so why not do it? But if you want the extra accuracy you can ask for the applanation - any decent optometrist will do it for you if you want. Some people prefer it.

Killakwinn 5y ago
I understand why these statements might seem extreme. A few points here: 1) I don't believe I've stated that dilated eye exams should never be done. One of the biggest reasons remote eyecare is relatively far behind compared to other specialties (remote dermatology, for example) is the need to visualize the retina up to the ora, where a lot of pathology (e.g. retinal holes) can hide. Currently, the only ways to visualize the retina this comprehensively are a) scleral depressed dilated eye exams and b) use of wide retinal imaging (e.g. Optos.) Theoretically, "a" can be done in the home via an "on-call" ophthalmologist or optometrist and "b" can be done via an eye van (ZSFG actually has this option,) but neither of these can scale very well. So we're working on a scalable solution that will enable the collection of data on par with what can be gathered via a traditional dilated eye exam. 2) My 2 cents re: cost-saving and efficient glaucoma screening methods is that we need portable IOP measurement devices. Since we're currently limited by existing technology, my vote is for a using tonopen (portable, affordable, accurate) over non-contact tonometry (nonportable, expensive, not accurate) when it comes to rapid remote screening.
- cik 5y ago
  I'm not an American, but I've had eye tests in both Canada and Israel. Just how expensive are these? In Canada they're free - covered by health care (Glaucoma). Regular eye tests in Canada cost ~$49 (clearly, Queen Street). In Israel they cost 22 NIS, about $6.
  - Killakwinn 5y ago
    That is INCREDIBLE. When someone is paying for a full eye exam out of pocket in the US, it can cost anywhere from $69 to $150 USD.
    - cik 5y ago
      For something that's preventative? Why would it cost a lot for preventative treatment that reduces overall health care spending?

alex-lx 5y ago

Because I was diagnosed with glaucoma, I do an air puff test per month to monitor my eye pressure. I'm not sure how inaccurate it is, but it still a very useful method, which is easy to run and unharmful

Killakwinn 5y ago
There are very few instances in which a patient with chronic glaucoma needs monthly IOP checks (vs someone who came into clinic with an acute event and goes on to need emergent surgery.) And in those cases where monthly IOP checks are needed, it is definitely not gold standard to use the air puff test. I'd say that measuring IOP every 3-4 months is a typical regimen for a patient with more advanced glaucoma; these measurements should always be done via the same method (Goldman applanation) at the same time of day (due to AM to PM fluctuations in IOP) to be the most accurate.