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    Question: A 23yo male patient was referred to me for photosensitivity when driving. He has no demonstrable ocular pathology, is complaining of light sensitivity while driving, and wants a prescription for densely tinted car windows. I’m concerned about extreme levels of tinting limiting his ability to see at night and potentially causing an accident. Is it ethical to diagnose idiopathic photophobia and give him a prescription for tinted car windows? 

    Answer: Your actions in this situation should be guided by your judgment as to whether tinted car windows are appropriate for your patient’s medical needs. It is suspicious that the patient’s photophobia exists only while driving, especially if the patient can calmly endure a complete eye exam.  After eliminating physiological causes of photophobia, including neurologic or medication-based causes, you can suggest tinted prescription lenses which can be just as effective as tinted car windows and far less expensive. In addition, there are certain lens tints that are better for photophobia (cause less dark adaptation) that are not available in window tinting material.

    State laws may differ about window tinting and if you decide to offer a prescription, you should familiarize yourself with state laws and/or consult with your liability carrier; most state guidelines use wording like “a genuine medical need” or “legitimate medical diagnosis”. Additionally, your concern regarding the patients’ ability to adequately see when driving at night is a legitimate one and speaks to your societal responsibility as a physician. Remember, it’s up to you to safeguard your professional reputation. You will always find yourself on strong ethical ground if you limit prescriptions like these to patient with overt findings.   

    To read the Code of Ethics, visit aao.org/ethics-detail/code-of-ethics.

    To submit a question, email ethics@aao.org.