Can emergency physicians accurately distinguish retinal detachment from posterior vitreous detachment with point-of-care ocular ultrasound?

Abstract

Study objective: There is significant overlap between the symptoms of patients presenting with retinal detachment (RD) and posterior vitreous detachment (PVD). Urgency to obtain consultation and treatment are dependent on the ability to accurately distinguish these two conditions. The objective of this study was to determine the ability of emergency physicians to differentiate RDs from PVDs using point-of-care (POC) ocular ultrasound.

Methods: Single blinded cross-sectional study at an academic medical center. Emergency physicians with varying ultrasound experience completed a brief tutorial on the sonographic findings of RD and PVD. Thirty POC ocular ultrasound clips obtained from ED patients with ocular symptoms were presented to emergency physicians. The sonographic findings in these clips were in agreement with the final diagnosis made by consultant ophthalmologists. There were 14 ultrasound videos showing PVD, 13 videos showing RD, and 3 normal ocular ultrasound videos. The subjects independently reviewed POC ocular ultrasound video clips and submitted their final interpretations.

Results: A total of 390 ocular video clips were reviewed by 13 emergency physicians. Overall, physicians were able to accurately diagnose the presence of a RD 74.6% (95%CI, 69.8-79.4) of the time, PVD 85.7% (95%CI, 77.6-93.8) of the time, and normal ultrasounds 94.9% (95%CI 87.3-100.0) of the time. There was no statistically significant relationship between correct diagnoses for ocular abnormalities or normal ultrasound images and number of previous ocular ultrasounds performed by emergency physicians.

Conclusion: Emergency physicians were modestly accurate in distinguishing RD from PVD on POC ultrasound.

Keywords: Ocular; Peripheral vitreous detachment, emergency department; Point-of-care; Retinal detachment; Ultrasound.