The value of dilation of the pupil far outweighs the inconvenience.In fact, I'd offer that if an exam is done without it, you potentially lose the following:
--full access to all the structure of the retina, macula, and associated blood vessels. Dilation opens up the aperture of the pupil enough for the examiner to see all there is to see. I could fill up two pages on what's "discoverable" on an eye exam.
--depending on age, dilation also paralyzes the ciliary muscle of the lens which is responsible for near-vision (sic: accommodation). The older you are, and the more you stare at a computer, the more that muscle stays tonically-contracted. When a distance vision exam is done on a tonically-contracted (accomodated) eye, the refraction may show a near-sighted condition that really doesn't exist.
Keep this in-mind: distance vision is a function of the cornea-macula distance. The lens is at its most flat state, adding next to nothing to visual acuity. When you get inside 20-inches, the lens changes configuration to increase the refractive index to keep object in focus. As people age, the ciliary muscle weakens and the lens becomes stiffer, which results in a gradual and progressive loss of ability to see up-close. Hence, the need for reading glasses. The two processes--near-sightedness and the inability to see up close as you age (Presbyopia) are two different processes.
To get back to "dilating" the eye, you can certainly bully and optometrist into not dilating your eyes, but you lose value and increase risk when you try to side-step that part of the exam. R.S. Carnes, M.D.
References: For physiology of the eye, the standard first-year medical school text is good enough: Hall and Guyton, “Medical Physiology.” For use of cycloplegics and fundascopic exams of the retina, almost any clinical practice manual, but “Harrisons Principals of Internal Medicine” details the range of diseases and conditions discoverable on fundascopic exam.