CLINICAL

  DIVERSIFY YOUR PORTFOLIO

DILATION AND GLARE

DISCUSS DILATION WITH PATIENTS; TREAT GLARE IN VARIOUS CIRCUMSTANCES

JEFFRY D. GERSON, O.D., F.A.A.O.

Q: WHAT IS THE BEST WAY TO HAVE STAFF EXPLAIN THE IMPORTANCE OF A DILATED EXAM?

A: It is somewhat frustrating that this is an issue so often. The need for an adequate fundus exam is akin to a cardiologist needing to closely examine his or her patients’ hearts, but I wonder whether he or she is asked to rationalize using a stethoscope?

A lot can be said about the tone used. If the person administering the drops, usually a tech in my office, makes it sound uncomfortable and scary, patients may balk and question the necessity. Confidence and caring/compassion can make it much easier to manage patients. Further, consider making dilation a routine part of the comprehensive exam by having your staff members do it and then explain the after effects.

In my practice, staff tell patients that they will likely be a little light sensitive and blurry up close for a few hours, but that those symptoms will subside. Should a patient express concern over dilation prior to instillation, have staff explain the importance of it: “Ms. Smith, by being able to see in the back of your eye, we can potentially catch and treat any eye diseases before they become a problem for you.”

Q: WHAT IS THE TREATMENT PLAN FOR PATIENTS WITH GLARE PROBLEMS, AND HOW DOES IT VARY FROM A POST-OP PATIENT WHO HAS AN ORGANIC ISSUE?

A: Light sensitivity and glare are fairly common patient complaints. There are a number of different causes, some of which can benefit from medical treatments. The two I will discuss are post-refractive surgery glare, due to pupil size, and light sensitivity, due to decreased macular pigment optical density (MPOD).

Post-refractive surgery patients usually experience glare due to surgery. Try prescribing a drop to constrict pupil size, for example brimonidine. A number of my patients who have undergone refractive surgery have reported reduced glare, specifically at night.

For patients who organically have light sensitivity, I always measure MPOD and usually find that it is sub-optimal. (Studies also show this correlation.) For decreased MPOD and light sensitivity, I start patients on a supplement that is built on a foundation of lutein and zeaxanthin. Several eye-specific formulas are available. (If you don’t have the capability to measure MPOD, it is a safe bet that supplementation or change in diet could be beneficial.) For patients who object to supplementation, I let them know which foods have higher amounts of zeaxanthin and lutein (spinach, kale, collard greens, goji berries, etc.). I educate these patients to stick with the treatment plan for 3 to 6 months to get noticeable benefit. It is amazing to see patients months later who do not need to wear sunglasses as much — especially when they are indoors! OM

Questions are based on reader responses to an Optometric Management online survey, which closed on Dec. 20.

DR. GERSON practices at Grin Eyecare in Olathe, Kan., a full-scope combined O.D./M.D. practice. Email him at jgerson@hotmail.com or visit tinyurl.com/OMcomment to comment on this article.