Objective: This study aimed to estimate the risk of errors of omission
inherent in the elimination of the routine dilated fundus examination
in asymptomatic patients presenting for routine eye checkups, or in p
atients with purely refractive complaints. Design: The study design wa
s a retrospective chart review. Participants: The authors reviewed the
records of initial visits of more than 3800 patients drawn from the p
ractices of 3 board-certified ophthalmologists with substantial genera
l ophthalmology components. Patients with best-corrected visual acuity
in either eye of poorer than 20/25, myopia greater than -3.00 diopter
s, or other risk factors for disease of the fundus or optic nerve (suc
h as ocular hypertension, glaucoma, previous ocular surgery, diabetes
mellitus, and history of retinal detachment) were excluded. The author
s identified 1094 such records that documented the findings of dilated
fundus examination, including indirect ophthalmoscopy. Main Outcome M
easures: The authors recorded the prevalence of all fundus abnormaliti
es, of those deemed clinically significant, and those beyond the view
of routine examination with the direct ophthalmoscope, Findings were s
tratified by patient age. Results: Of the 1094 eligible records, 53 (4
.84%) had recorded fundus abnormalities. Of these, 23 were of no adver
se ophthalmologic consequence and were considered clinically insignifi
cant, Of the 30 (2.74%) potentially significant findings, only 3 were
located beyond the view of routine examination with the direct ophthal
moscope (0.274%; 95% confidence limits: 0.56%-0.80%), The prevalence o
f fundus findings increased strongly with increasing patient age, from
2.4% younger than age 20 to 14.8% older than age 60, Clinically signi
ficant findings increased from 0.8% younger than age 20 to 8.9% older
than age 60. Conclusions: The authors estimate the rate of detection t
hrough routine dilated fundus examination of clinically significant fu
ndus lesions in asymptomatic patients at 2.73% (95% confidence limits,
1.86%-3.80%). One tenth of these are beyond the view of the direct op
hthalmoscope, The prevalence of fundus abnormalities increases tenfold
with increasing patient age.