THE VALUE OF ROUTINE DILATED PUPIL SCREENING EXAMINATION

We evaluated the cost-effectiveness of routine dilated fundus examinat ion in improving visual outcomes. The cost of routine dilated fundus e xamination was related to the number of preventable cases of vision-th reatening 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. Th e number of preventable cases was calculated for multiples of a 10% pr obability of prevention. The cost of RDE was determined from the numbe r of undilated examinations in the same population and period and the cost of a single RDE. The number of patients who underwent undilated e xamination was estimated by random medical record review. The addition al cost of a single RDE was determined from estimated examination time s and payroll costs. Among patients without risk factors, 38 were iden tified for whom undilated examination rather than RDE had been perform ed. If prevention had been 10% effective, the substitution of 50 000 R DEs for undilated examinations costing the provider $433 000 would hav e been required per prevented case. These results suggest that most pe ripheral retinal diseases cannot be prevented by RDE. Routine dilated examination is an expensive test per prevented case. Published clinica l guidelines lack evidence to recommend its use.