The value of routine dilated pupil screening examination
T. J. Batchelder, B. Fireman, G. D. Friedman, B. R. Matas, I. G. Wong, M. E. Barricks, S. Burke and L. Beasley
Department of Ophthalmology, Kaiser Permanente Medical Center, Richmond, Calif., USA. tim.batchelder@ncal.kaiperm.org
We evaluated the cost-effectiveness of routine dilated fundus examination
in improving visual outcomes. The cost of routine dilated fundus
examination was related to the number of preventable cases of
vision-threatening peripheral retinal disease. Patients with these diseases
who had no risk factors were ascertained in a population of 1.75 million
adults for a period of 6 months. Those whose last examination had been
undilated were identified because only for them could routine dilated
examination (RDE) have been substituted for undilated examination. The
number of preventable cases was calculated for multiples of a 10%
probability of prevention. The cost of RDE was determined from the number
of undilated examinations in the same population and period and the cost of
a single RDE. The number of patients who underwent undilated examination
was estimated by random medical record review. The additional cost of a
single RDE was determined from estimated examination times and payroll
costs. Among patients without risk factors, 38 were identified for whom
undilated examination rather than RDE had been performed. If prevention had
been 10% effective, the substitution of 50,000 RDEs for undilated
examinations costing the provider $433,000 would have been required per
prevented case. These results suggest that most peripheral retinal diseases
cannot be prevented by RDE. Routine dilated examination is an expensive
test per prevented case. Published clinical guidelines lack evidence to
recommend its use.
