The reason we dilate pupils is so we can see inside the eye. Historically, we needed to do that so we had a good view of the retina. Since 2002, however, we use the Optomap which allows for a wide-field digital retinal image taken through a normal-sized pupil without drops. Optomap allows us to see the full extent of the retina and you get to review that with us on a flat-panel monitor so you can see what we see.
A June 2012 American Journal of Ophthalmology report compared non-dilated ultra-widefield images and dilated diabetic 7 field (ETDRS) photos in 103 patients with varying levels of diabetic retinopathy. The two images exactly matched for clinical level of diabetic retinopathy in 84% of patients and were within one level of agreement in 91%. Sensitivity and specificity of ultra-widefield images for detecting the presence or absence of diabetic retinopathy (DR) diagnosed on ETDRS photos were 99% and 100%.
There are cases where dilation is necessary, such as peripheral cataracts and certain retinal problems where we need a more 3-D view. Routine dilation for a vision exam is not always necessary. When we do have to dilate, the drops make the pupil bigger and freeze the focusing system. In summary, while a comprehensive eye health exam formerly required dilation, technology with ultra-wide field digital imaging has redefined the standards. Our patients benefit and appreciate this new technology.