2019F Dilated macular exam performed, including documentation of the presence or absence of macular thickening or hemorrhage and the level of macular degeneration severity (EC)

Name of the Procedure:

Dilated Macular Exam (DME)

Summary

A dilated macular exam is a detailed eye examination where the pupils are dilated using eye drops to allow an eye care specialist to thoroughly examine the macula, which is the central part of the retina responsible for sharp vision. This procedure can help in diagnosing and monitoring conditions affecting the macula like macular degeneration, thickening, or hemorrhage.

Purpose

The primary purpose of a dilated macular exam is to:

• Diagnose macular conditions such as age-related macular degeneration (AMD), diabetic retinopathy, or macular edema.
• Assess the presence or absence of macular thickening or hemorrhage.
• Determine the severity level of macular degeneration if present.

Indications

This procedure is typically indicated for patients who have:

• Symptoms like blurry or distorted vision, dark spots in central vision, or difficulty reading.
• Risk factors such as age above 50, family history of macular degeneration, or diseases like diabetes.
• Ongoing monitoring of known macular conditions to track progression or response to treatment.

Preparation

• Patients may be advised to bring sunglasses as their eyes will be sensitive to light post-exam due to dilation.
• Inform the doctor about any medications being taken, as some may affect pupil dilation.
• No fasting or special medication adjustments are generally required.

Procedure Description

1. The patient will have their eye history checked and a preliminary vision test conducted.
2. Special eye drops will be administered to dilate the pupils. It may take 15-30 minutes for the drops to take full effect.
3. Once the pupils are dilated, the eye care specialist will use an ophthalmoscope or a slit-lamp biomicroscope to examine the macula closely.
4. The specialist will look for signs of macular degeneration, thickening, or hemorrhage, documenting their presence or absence.
5. The level of macular degeneration severity, if any, will also be noted.

Duration

The entire procedure generally takes about 30-60 minutes, including the time needed for pupil dilation.

Setting

The procedure is performed in an eye doctor's office, typically an ophthalmologist or optometrist's clinic.

Personnel

• Ophthalmologist or Optometrist
• Ophthalmic Technician or Assistant

Risks and Complications

• Temporary blurred vision due to dilation
• Sensitivity to light for a few hours following the procedure
• Rarely, an allergic reaction to the dilation drops
• Potential increase in eye pressure, which is uncommon

Benefits

• Accurate diagnosis and monitoring of macular conditions
• Early detection of macular diseases leading to timely treatment
• Can prevent further vision loss if conditions are identified and managed early

Recovery

• Patients are advised to wear sunglasses post-exam due to light sensitivity.
• Avoid driving until vision returns to normal, usually within a few hours.
• Follow-up appointments may be scheduled based on findings.

Alternatives

• Optical Coherence Tomography (OCT) for detailed imaging of the retina.
• Fluorescein Angiography to visualize blood flow in the retina, especially if more detailed imaging is required.
• Direct examination without dilation, though this is less comprehensive.

Patient Experience

Patients may feel mild discomfort from the dilation drops and experience blurry vision and light sensitivity for several hours after the procedure. The process is generally painless, and any discomfort can be managed with rest and avoiding bright light.