The College of Optometrists

Is it a legal requirement to dilate a diabetic patient if he or she is not under the care of the HES. I had a diabetic patient today, she has been diagnosed as diabetic by her GP 7 years ago, she has a large pupils and I had a good view of the fundus. she never had a diabetic screening for DR. is it ok not to dilate if a good view of the fundus is possible, VA 6/6 (no maculopathy. please help.

Hi again

No its not a legal requirement - only a guideline of good practice. I think quite a few optoms would not dilate at every patient visit. Hopefully, they gave the patient a choice and the reasons.

The idea behind dilating is to get a stereoscopic view of the fundus - as that reveals far more than a monocular view which you get from a small pupil.

If you don't wish to dilate then best practice would be to note that on the report form that you send to the gp. (and the reason why).

Things are changing and there will be NHS retinal photography for diabetics being rolled out this year.

Its worth noting that diabetic retinopathy progression can happen quickly - so all clear today can be maculopathy or even pre-proliferative within a year. This is rare however and happens mainly in poor, or patient negligent diabetic control, or where there are other health complications.

have a nice weekend = steve

Remmeber the other benefit of dilating is that you are also getting a better view of the periphery where you may get proliferation of abnormal vessels as well as in the more easily seen central retina.

Be aware that if you chose not to dilate and miss something you will need to have had a very good reason not to dilate as every ophthalmologist would dilate these patients without thinking twice and they will be the ones talking about your management in court. Not neccesarily fair but then that's life!