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The value of routine dilated pupil screening examination
T J Batchelder1, B Fireman, G D Friedman
1Department of Ophthalmology, Kaiser Permanente Medical Center, Richmond, Calif., USA. tim.batchelder@ncal.kaiperm.org
Archives of Ophthalmology (Chicago, Ill. : 1960)
|September 23, 1997
Summary
Routine dilated fundus examination (RDE) is costly and ineffective for preventing most peripheral retinal diseases. Evidence does not support its routine use for improving visual outcomes.
Area of Science:
- Ophthalmology
- Public Health
- Health Economics
Background:
- Routine dilated fundus examination (RDE) is a common eye screening procedure.
- The cost-effectiveness of RDE for improving visual outcomes remains under-evaluated.
- Peripheral retinal diseases can lead to vision loss if not detected and treated.
Purpose of the Study:
- To evaluate the cost-effectiveness of routine dilated fundus examination (RDE) in preventing vision-threatening peripheral retinal diseases.
- To determine the number of preventable cases and associated costs of RDE.
- To assess the evidence supporting current clinical guidelines for RDE.
Main Methods:
- A population of 1.75 million adults was studied over 6 months.
- Identified patients without risk factors whose last examination was undilated.
- Calculated preventable cases based on 10% probability and estimated RDE costs from examination times and payroll.
Main Results:
- 38 patients without risk factors had undilated examinations instead of RDE.
- An estimated 50,000 RDEs would be needed per prevented case, costing $433,000.
- Most peripheral retinal diseases were not preventable by RDE.
Conclusions:
- Routine dilated fundus examination is an expensive intervention per prevented case.
- Current clinical guidelines recommending RDE lack sufficient supporting evidence.
- RDE is not a cost-effective method for preventing most peripheral retinal diseases.