It's not that often when my family pays much attention to what I do at work (which is probably good for work/life balance) except when, on occasion, I show up in the local newspaper.
1 Recently, I had a few quotes in a story entitled “Do You Really Need Dilation at Every Eye Exam?” because I co-authored an article that included relevant evidence-based guidelines.
2
I pointed out that routine dilated eye exams may not be necessary for many people unless you are older or have great reasons like symptoms, signs, and strong family histories. Why? Because the evidence in the peer-reviewed literature guided me.
To date, this is what the literature says: “A 5-year observational study of a nationally representative cohort of Medicare beneficiaries showed that patients 65 and older who had more regular eye examinations experienced less decline in vision and functional status than those who had less frequent examinations.”
2,3
There is little evidence in the literature to define the optimal frequency of eye examinations of patients under 65 with no eye symptoms or signs. There is some evidence that clinically significant fundus abnormalities in asymptomatic patients increase with age.
2,4 Still, other evidence suggests that the diagnostic yield of dilated fundus examination in asymptomatic patients is low, particularly in younger age groups.
2,5
Specifically, the prevalence of fundus findings increased strongly with increasing patient age, from 2.4% younger than age 20 to 14.8% older than age 60. Clinically significant findings increased from 0.8% younger than age 20 to 8.9% older than age 60.
2,4 Overall, there isn't enough data in the peer-reviewed literature to warrant routine dilated eye exams for those without risk factors and symptoms before the age of 40 for ocular, vision, and systemic disease detection.
2,5
However, all of this peer-reviewed evidence did not appear in the newspaper article, although some of it did. Instead, what was quoted said: “This is such a hot-button issue. It's confusing because you're hearing different things from different doctors.” “What the evidence does show is that our ability to find things is not that great until the later ages.” “Beyond the temporary effects, there's little harm in doing a complete dilated exam, but if everything is totally fine and you have no family history, just know that the chances that you'll find anything are just extremely low.”
As you might expect, our take on the literature came as a surprise not only to my family but also to our office staff, other medical professionals, and many of the lay public, as well as a good number of eye care professionals. Those around us may be more interested in what we do than we think! Who knows, I could be wrong, but I have only the existing evidence-based literature to go by. As we all realize, not everything we are taught today is true tomorrow. There's an art and an evolution to the science of medicine.
Our job is to continue to perform the best science we can to answer today's critical questions. Here at Translational Vision Science and Technology, we take this charge to heart and will continue to do the best we can to publish works that not only help us cross the bench to the bedside gap but also communicate the science and technology that will guide the standards of care of tomorrow.
Back to the point of this editorial: We in eye science must better communicate what we discover in ways that are understandable to those around us who care. That is everybody.