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The Ethics Committee response, below, is based on the Ophthalmic Mutual Insurance Company (OMIC) article “Warning Patients About Side Effects of Dilating Drops,” by Anne Menke, RN, PhD, OMIC Risk Management.1
Q: A patient of mine was killed in a car accident. The other driver’s eyes had been dilated. What are the ophthalmologist’s responsibilities re¬garding informing patients about the effects and risks of pupil dilation?
A: Informed consent is based on what a “reasonable layperson” would want to know prior to undergoing a procedure, such as pupil dilation. Ophthalmologists can make patients aware of potential side effects, such as blurry vision for the following 4 to 8 hours. Dilating drops may induce photophobia, lack of accommodation, glare, and decreased contrast threshold and high-contrast visual acuity. These visual changes can be a problem, par¬ticularly for those patients whose vision and mobility may already be compro¬mised. Dilating drops can—although this is rare—provoke allergic reactions, angle-closure attacks, and systemic reactions such as increased blood pressure, arrhythmias, tachycardia, and dizziness—a reasonable person might want to be informed of these possible side effects.
Q: Is it necessary to have the pa¬tient sign a consent form if a proce¬dure will include dilation?
A: No, but you should consider fully documenting your discussion with the patient, and you may want to consider asking first-time patients whose eyes will be dilated to sign a form acknowl¬edging that they have been apprised of the risks. OMIC has a sample dilation consent form available at www.omic.com.
Q: What is my office’s responsibil¬ity before the appointment to apprise the patient of these risks?
A: It is helpful to advise new patients as they are making their appointment that their eyes will be dilated so that they can prepare. Patients can be told that they will need to wear sunglass¬es and avoid driving and operating machinery until their pupil dilation wears off.
Q: What needs to happen during the exam?
A: Involve the patient in the decision-making process and discuss potential side effects with the patient. Consider making notes about the discussion, the offer of sunglasses (or the reminder to wear them), and any warning, especially the possible impact on driving.
Q: Should I refuse to dilate if a patient insists on driving?
A: If a patient insists on driving after dilation, consider the patient’s visual acuity and driving ability, the driving conditions, and how urgently you need to diagnose and/or treat the presenting condition. As you know, the patient may be at more risk from a delayed diagnosis.
Q: What is my office’s responsibil¬ity to patients who are experienced with dilation?
A: It may be helpful to place a sign in your practice’s waiting room re¬minding patients whose eyes are dilated not to drive, to wear sunglasses, and to let the staff know whether they need assistance walking while their eyes are dilated. Disposable sunglasses can be given to the patient in the exam room. Some practices place a bowl of sun¬glasses at the check-out desk with a sign.
To submit a question to the Ethics Committee, email ethics@aao.org.
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1 www.omic.com/warn-patients-about-side-effects-of-dilating-drops/.