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As healthcare professionals, we have an obligation to provide our patients the highest levels of care, and pharmacological dilation represents the gold standard in this regard. Given that “failure to diagnose” is by far the most common reason optometrists are successfully sued, we have yet another good reason (beyond our desire to provide excellent patient care) to embrace the inconvenient virtue of pupillary dilation. During one of Dr. Thomas’s externships, the brilliant ophthalmologist’s routine dilation protocol was use of 1% tropicamide and Perspective on Pupillary Dilation This case of synechial anterior uveitis finally yielded to atropine, Durezol and 10% phenylephrine. The residual lens face “tattooing” of iris pigments will largely dissipate over the years. Patients may not like this experience but that’s no excuse for avoiding a vital step that can make or break a diagnosis. SECTION I: STRATEGIES FOR SUCCESS PAREMYD OPHTHALMIC SOLUTION • A combination of tropicamide 0.25% and 1% hydroxyamphetamine HBr, an indirect acting sympathomimetic (adrenergic agonist). • An excellent, less intrusive dilating drug we use for routine dilation. • For patients who are of African origin and/or patients with diabetes, we commonly use 1% tropicamide with 2.5% phenylephrine. • Marketed by Akorn in a 15ml bottle REVIEW OF OPTOMETRY JUNE 15, 2020 15 10% phenylephrine. There was no adverse event with any of these hundreds upon hundreds of mostly elderly patients. We share this to provide a perspective on the safety of both phenylephrine concentrations. Since the 2.5% formulation (in combination with 0.5% or 1% tropicamide) provides ample dilation, we rarely have a practical need to use the 10% concentration. However, we do find the 10% concentration can be adjunctively helpful in breaking some recalcitrant synechiae, and for subsequent visits of patients known to dilate poorly. The world and the way we interact is changing, perhaps forever. Optometry’s practice patterns must also change, but not in the ways one might be thinking. I will share a number of data points that should be a wake-up call for all optometrists, regardless of practice environment, to fully embrace providing medical eye care services. The data is a compilation from sources including CMS/Medicare, Census Bureau, National Eye Institute, optometric and ophthalmology training programs and insurance utilization statistics.
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