This spring, a rash of cases of a rare, but often fatal, form of cancer known as ocular melanoma was reported, with 50 individuals in North Carolina and Alabama diagnosed over a relatively short time frame. Thirty eight of these patients actually lived in the same facility and four died from the disorder.
Carol Lally Shields, MD, my classmate at Wills Eye Hospital, where I trained, treated many of these patients.
This recent increase in a typically rare eye disease highlights the importance of screening for this and other serious eye disorders with a fully dilated eye, as opposed to “photographs” being taken of the back of your eye. I, therefore, stress to you the importance of a dilated eye exam, at least every two years until the age of 60, then yearly afterwards.
For those who have not experienced a dilated eye exam, drops are instilled in the eyes, significantly enlarging the pupil in about 15 minutes. This enables your doctor to easily see all around the back of the eye, not just the center.
What are we screening for?
In a dilated eye exam, we are looking at the very tiny blood vessels in the back of your eye to screen for diabetes and high blood pressure. The optic nerve comes directly from the brain and can be swollen in brain tumors and other conditions that raise the pressure of the spinal fluid.
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Melanoma, a malignant tumor of pigmented cells, can be found in the back of the eye in the layer known as the uvea. While melanoma is rare, it is very common to find small “nevi” or moles in the back of the eye. These are smaller, benign tumors of pigmented cells like freckles on your skin. These should be monitored at least yearly to see if any significant changes are occurring in them, which could signal early malignancy. Unfortunately, you can’t see a freckle in the back of your eye to monitor it yourself for changes.
The presence of “flashing lights” and/or floaters is a common reason for an emergency dilated eye exam. In these cases we look carefully for a retinal tear, which is a small hole or tear in the retina which is easily sealed with laser, or a retinal detachment where the retina is coming off the back of the eye, requiring surgery.
When dilated during an eye exam, you’ll experience light sensitivity and blurry vision requiring sunglasses, typically supplied when needed, upon leaving the office. If you have someone to drive you, that’s always best, but most people drive themselves home wearing sunglasses.
None of us relish the thought of having our eyes dilated, but the ability to perform such a comprehensive exam provides an invaluable advantage when diagnosing and preventing eye issues.
Don’t chance missing significant problems
In our own practice, we have diagnosed patients with ocular melanoma who have not had their eyes dilated previously, instead relying on a photo taken of the back of the eye, using a type of low resolution, wide angle photography. Optos, the camera manufacturer, says that 80 percent of the back of the eye can be seen.
We also see many patients for second opinions with “spots” or “hemorrhages” that are misinterpreted on these photographs. These cause significant anxiety for the patient, and often expensive additional testing and, at the least, repeat photographs.
If you do have significant pathology suspected on a photograph, additional testing should be billed to your insurance.
So, as with many things, it’s “no pain, no gain.” You need to be dilated. That’s an important part of what you’re paying for in an eye exam.
Matthew Ehrlich, MD, is a board certified ophthalmologist specializing in cataract surgery and other advanced eye procedures. He is the founder of the Eye Center of the Rockies, located at 232 Broadway in Eagle. He can be reached at 970-926-7773 or at http://www.EyeCenterRockies.com.
