Retinal Exam Options Our commitment is to offer all patients the highest standard of care available. Your annual eye exam at Tempe Eyecare Associates includes a detailed examination of your retina. This examination is important in the early detection of disorders which may be harmful to your vision; including glaucoma & macular degeneration. System conditions such as high blood pressure & diabetes can also have vision and/or ocular effects. There are two available options for this examination; both are effective & acceptable: Option 1 – Dilation of the pupils Dilation is a safe and common procedure that utilizes drops to increase the size of your puils so the doctor can get a better look into your eyes. Dilation can have the following side effects: Sensitivity to light Requires eye drops Blurred vision (especially reading) Possible stinging Option 2 – Ultra-Wide Digital Retinal Imaging (Optos Daytona) Retinal imaging can be performed without dilation of your pupils and is a very comfortable procedure. The benefits of digital retinal imaging are: No light sensittivity No blurred vision No drops or stinging Maintain a digital record for documentation There is a $45.00 fee for this service that will not be covered by insurance. NOTE: DEPENDING ON YOUR CONDITION, A SMALL PERCENTAGE OF PATIENTS MAY STILL NEED TO BE DILATED EVEN IF THEY CHOOSE THE MAP. YOUR DOCTOR WILL ADVISE ACCORDINGLY. Please check one of the options below:(Required) I accept Retinal Imaging at a cost of $45.00 I accept Dilation I decline both Retinal Imaging and Dilation I understand that these procedures are recommended as appropriate for me and if I elect to decline both dilation and digital imaging, my doctor will not be able to adequately assess for retinal pathology, optic nerve disease or other anomalies.Name(Required) First Last Signature(Required)Date(Required) MM slash DD slash YYYY CAPTCHA Δ