Non-Mydriatic Ocular Fundus Imaging on Consecutive Patients Presenting to a General Emergency Department with Vision Complaints

Abstract

Purpose: Visits to emergency departments (ED) for vision complaints are common, especially where access to eye-care may be limited. However, ophthalmologists are rarely available in EDs, resulting in costly/often unnecessary transfers to centers with ophthalmic coverage. Implementation of non-mydriatic color fundus photographs with optical coherence tomography (NMFP-OCT) in general EDs has the potential to facilitate on-site ophthalmologic diagnoses and opens the door to tele-ophthalmology for remote triage and rapid treatment. Our goal was to evaluate which ocular complaints/pathologies would benefit most from NMFP-OCT in a general ED.

Design: Prospective quality improvement study.

Subjects: Adult patients presenting to our general ED with any vision complaint who had NMFP-OCT obtained in our ED from 08/24/2024 to 09/08/2024.

Methods: In this prospective quality improvement project over 16 consecutive days/nights, NMFP-OCT (table-top Maestro2, Topcon-Japan) was ordered for all patients presenting to our ED with any vision complaint. Demographic information, final diagnosis and NMFP-OCT findings were collected.

Main outcome measures: Number of patients with vision complaints who received NMFP-OCT, number of in-person ophthalmology consultations, number of papilledema complaints ruled-out remotely.

Results: Of 1838 ED visits over 16 days/nights, 182 (9.9%) patients had vision complaints; 162 (89%) underwent NMFP-OCT in the ED. 82/162 patients (50.6%) also had an in-person ED examination by an ophthalmologist. NMFP-OCT was ordered for: vision loss (51; 31.5%); other visual changes (13; 8.0%); papilledema/papilledema rule-out (60; 37.0%); painless red eye (7; 4.3%); eye/orbital pain (28; 17.3%); diplopia (3; 1.9%). 104/162 patients (64.2%) had relevant findings on NMFP-OCT; 31/162 (19.1%) had non-relevant incidental findings. NMFP-OCT was most useful in patients with posterior segment pathology (45; 27.8%) and neurologic disorders (72; 44.4%), by either demonstrating pathology such as acute retinal ischemia (5; 3.1%), optic disc edema (14; 8.6%), retinal detachment/vitreous hemorrhage (3; 1.9%), posterior uveitis/retinitis/vasculitis (3; 1.9%), retinopathy/maculopathy (9; 5.6%), or by ruling out papilledema (52; 32.1%).

Conclusion: Given that 10% of all ED visits were for vision complaints, having NMFP-OCT obtained in our general ED allowed for rapid/reliable diagnosis of ocular emergencies mostly involving the posterior segment, including acute retinal arterial ischemia and papilledema/rule-out papilledema, thereby facilitating rapid remote triage and treatment.

Keywords: Vision loss; emergency department; non-mydriatic ocular imaging; optical coherence tomography; papilledema.