Can Patients with Suspected Glaucoma Safely Undergo Dilated Fundus Examination?

Q: Can Patients with Suspected Glaucoma Safely Undergo Dilated Fundus Examination?

Hello： If it is not angle-closure glaucoma, dilation of the pupils does not necessarily lead to acute glaucoma. <br>After the examination, please check the intraocular pressure; if it is indeed elevated, there are treatment options available. <br>There is no need to worry too muc

Can a suspected glaucoma patient undergo dilated fundus examination for retinal detachment?

Dear Director Gao,
I am currently 27 years old and have over 500 degrees of myopia in both eyes.
I previously underwent a glaucoma examination, and since both the intraocular pressure and visual field test results were normal, the examining physician noted only mild optic nerve damage in the left eye.
They believed it was not yet at a stage to diagnose glaucoma and recommended regular follow-ups, so no definitive glaucoma diagnosis or treatment has been initiated.
Last night, while using my phone, I suddenly noticed a small area of flickering light in my left eye (toward the lower left side).
It was not a point of light or a beam, but rather a sensation similar to fluctuations.
I attempted to observe my surroundings, but the fluctuation persisted.
When I closed my eyes, I could still feel rapid movements, and when I opened my eyes to look at things, there was a sense of obstruction, although I wasn't actually seeing anything blocking my vision.
This situation lasted for about five minutes before returning to normal.
Concerned, I searched online for related information, fearing it might be a retinal detachment issue.
Additionally, although I have not been formally diagnosed, I believe I may have floaters, as I see small black dots moving with my line of sight, and when I lower my head and then raise it, I see many small points of light.
Today, I am experiencing the same condition, but it has not worsened.
Subsequently, I visited a nearby ophthalmology clinic half an hour later.
The doctor conducted a basic eye examination and measured my intraocular pressure, concluding that there was no immediate danger.
Due to the clinic's time constraints, they scheduled a dilated fundus examination for next Monday to confirm whether there is a retinal detachment.
However, since I have a suspected glaucoma condition, I have read that it may not be suitable to use mydriatic agents for examination, as I am concerned it could trigger acute glaucoma.
Therefore, I would like to ask if there are alternative methods for examination.
I apologize for the lengthy description of my situation, and I appreciate your guidance on this matter.
Thank you.

27 sui nvxing, 20~29 year old female. Ask Date: 2016/07/17

Dr. Gao Pilin reply Ophthalmology

Hello: If it is not angle-closure glaucoma, dilation of the pupils does not necessarily lead to acute glaucoma.
After the examination, please check the intraocular pressure; if it is indeed elevated, there are treatment options available.
There is no need to worry too much.
A detailed examination of the retina usually requires pupil dilation.
The ophthalmology department at Puzi Hospital in Taiwan is open Monday to Friday from 8:00 AM to 12:00 PM and Wednesday afternoons from 1:00 PM to 4:30 PM.
Online responses can only serve as a reference; it is still necessary to seek medical care at a healthcare facility if needed.
I hope to have the opportunity to serve you.
Gao Pi-Lin

Reply Date: 2016/07/17

More Info

When it comes to patients with suspected glaucoma undergoing a dilated fundus examination, there are several important considerations to keep in mind. Glaucoma is a group of eye conditions that can lead to damage to the optic nerve, often associated with increased intraocular pressure (IOP). The concern with dilating drops is that they can potentially increase IOP, which may pose a risk for patients with glaucoma or those suspected of having it.

In your case, you are 27 years old with a history of myopia and previous examinations showing normal IOP and visual fields, but with some mild optic nerve damage in your left eye. The recent symptoms you described, such as the flickering light and the sensation of rapid eye movement, are concerning and warrant further investigation. Your concern about the potential for retinal detachment is valid, especially given the acute nature of your symptoms.

Typically, a dilated fundus examination is crucial for assessing the health of the retina and optic nerve. However, in patients with suspected glaucoma, the use of mydriatic agents (dilating drops) can be a double-edged sword. While these drops allow for a better view of the retina, they can also lead to an increase in IOP, particularly in individuals with narrow angles or other predispositions to angle-closure glaucoma.

In your situation, since you have already been evaluated by an ophthalmologist who did not find any immediate danger, it is essential to follow their recommendations. The fact that they scheduled a follow-up for a dilated examination indicates that they believe it is safe to proceed with further testing, but they will likely monitor your IOP closely before and after the procedure.

If there are concerns about the use of dilating drops, there are alternative methods to assess the retina and optic nerve without inducing dilation. These may include:
1. Optical Coherence Tomography (OCT): This non-invasive imaging test provides detailed cross-sectional images of the retina and can help assess the thickness of the nerve fiber layer, which is crucial in glaucoma diagnosis.

2. Fundus Photography: This technique captures high-resolution images of the retina and optic nerve head, allowing for detailed evaluation without the need for dilation.

3. Visual Field Testing: This can help assess peripheral vision, which is often affected in glaucoma, and can be done without dilation.

4. Non-contact Tonometry: This method measures IOP without the need for anesthetic drops and can be performed before any dilation.

It is crucial to communicate your concerns with your ophthalmologist. They can provide reassurance and may adjust their approach based on your specific situation. If you are particularly anxious about the potential for increased IOP, express this to your doctor, and they may consider alternative examination methods or take additional precautions during the dilated exam.

In summary, while dilated fundus examinations are essential for assessing eye health, patients with suspected glaucoma should approach this procedure with caution. Discussing your concerns with your healthcare provider will ensure that you receive the most appropriate and safe care tailored to your needs.

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