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Comment by sokoloff | Hacker News Reader

At my most recent eye exam, I paid an extra $40 or so to have some kind of digital retinal imaging done (no dilation required) and the amount of detail the doctor could see was phenomenal to my eye (no pun intended).

They were perhaps making more money on it, but seemed to push it as medically superior to the dilation and manual inspection process.

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I'm surprised, I thought the digital imaging was the standard now. The eye doctor I've been going to for several years now only does the new method and doesn't even offer dilation afaik.

Insurance doesn't cover it, so some doctors don't bother with it. I was caught by surprise when I tried out my wife's ophthalmologist. Dilation only, no option for a digital scan, my choices were get dilated or get out. I'm not going back there.

That's exactly consistent with what they said to me. "Insurance covers the dilation procedure; the digital imaging is better but you have to pay $X [$40 or $49, I forget] out of pocket." "Which one is medically better?" "Digital." "Let's do that one."

Even as they did the multiple exposures, I was wondering if I was getting suckered, but when the doctor showed me what she could see in the digital images and that she could use them to track any changes over the years, I felt really good about spending the money.

For me that 'tracking over the years' was secondary. Having had glasses for years the hours of not having to hide in the dark was a 'shut up take my money' moment.

You compared that with what they could see with the prehistoric method?

Obviously, I don't have any idea what she could see using the old method. However, when she pulled up the image on the screen and walked me through what she was seeing, I could judge from her overall excitement in showing me the details and from what I was able to see, that she thought it was a great tool and I had no reason to doubt and some reasons to believe.

Even if you can see pretty much the same thing, there's still the benefit of getting comparison images.

That cannot be understated. I've got something in one eye, which shows up on both digital scan and normal dilation. But the archives of the digital scans makes it possible to clearly see if it is changing over time.

Interesting, my insurance covered it last year. However it was related to eye trauma rather than a regular vision visit, so perhaps that's why.

My understanding is that would be covered under medical insurance?

Yes, acute care for eye injuries (or potential injuries like to verify the eye is fine after it was hit) is covered under health insurance (in the US) and not typically covered by vision insurance. Vision insurance mostly covers your routine exams, glasses, and contacts. If you have a real health issue (glaucoma, macular degeneration, etc.) with your eyes and not a vision issue (myopia, presbyopia) then that's also covered under your health insurance and not your vision insurance.

Here in AUS, essentially every single optometrist requires digital imaging. Oh, and it’s subsidised by the government.You don’t pay a single cent for a prescription. Bonus: If you have private optical health insurance it will likely cover two pairs of prescription glasses per year. Not too bad a deal if you ask me!

Optomap is the (commercial?) name for this. A previous Silicon Valley ophthalmologist I went to swore by it and I saw the value, given a family history of macular degeneration, but out here no one has the very expensive machine.

I don't even care if it makes them more profit than drops, I'm MUCH more likely to use the digital system rather than drops, so the value is there for me.

My local glasses shop had this as an option, but only at a location that was a bit out of my way. Would have loved to try it, though!

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