Emergency Department Nonmydriatic Fundus Photography Expedites Care for Patients Referred for Papilledema

Abstract

Purpose: Emergency department (ED) visits to rule out papilledema or for papilledema workup are increasing. Our goal was to evaluate whether implementation of a hybrid true color nonmydriatic fundus photography and OCT camera in our ED (NMFP-OCT) combined with a "papilledema protocol" could avoid in-person ophthalmology consultations and accelerate the evaluation for papilledema.

Design: Prospective quality improvement study.

Participants: Adult patients who underwent NMFP-OCT camera examination in our ED from June 9, 2023, through June 30, 2024, to rule out papilledema or perform a papilledema workup.

Methods: We collected final diagnoses, ED lengths of stay, and whether an in-person ophthalmology consultation was performed in addition to remote interpretation of images. We compared ED lengths of stay with previous data prospectively collected in 2022 before installation of the NMFP-OCT camera in the ED.

Main outcome measures: Median ED length of stay in hours and number of patients in whom papilledema was ruled out remotely.

Results: For patients referred to the ED for papilledema, the ED NMFP-OCT camera reduced the median ED length of stay to 12 hours (interquartile range, 7.5-26.5 hours; 337 patients) compared with 27 hours (interquartile range, 19-33 hours; 85 patients) in 2022 (P < 0.001). For the 199 patients in whom papilledema was ruled out with the NMFP-OCT camera, the ED length of stay decreased from 24.5 hours (interquartile range, 10-29 hours) in 2022 to 9 hours (interquartile range, 6.5-18.5 hours) after installation of the ED NMFP-OCT camera (P = 0.007); papilledema was ruled out remotely without in-person ophthalmology consultation in 185 of 199 patients (93%). For patients with previously known idiopathic intracranial hypertension, ED stay decreased from 24 hours in 2022 (interquartile range, 12-28 hours) to 10 hours after installation of the ED NMFP-OCT camera (interquartile range, 7.5-17 hours; 50 patients; P = 0.02).

Conclusions: Implementation of the NMFP-OCT camera in our general ED reduced the ED length of stay of patients being evaluated for papilledema by 56% and mostly avoided in-person ophthalmology consultations when papilledema was ruled out remotely on ocular imaging, reducing the burden on residents and on-call ophthalmologists.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Headache; Nonmydriatic fundus photography; Papilledema.