Abstract Details

Title Non-Mydriatic Ocular Fundus Photography among Headache Patients in an Emergency Department

Topic Headache

Presentation(s) P03 - (-)

Poster/Presentation
Number 111

Objective

Background BACKGROUND: Examination of the ocular fundus is one aspect of the physical examination that is helpful in screening for "red flags," such as papilledema, that suggest a more ominous cause of headache. However, ocular funduscopy is rarely and poorly performed by non-ophthalmology personnel, especially in acute care settings such as the ED.

Design/Methods DESIGN/METHODS: Cross-sectional study of prospectively enrolled adult patients presenting to our ED with a chief complaint of headache. Ocular fundus photographs were obtained using a non-mydriatic fundus camera that does not require pupillary dilation. Demographic and neuro-imaging information were collected. Two neuro-ophthalmologists independently reviewed photographs for findings relevant to acute care. The results were analyzed using univariate statistics and logistic regression modeling.

Results RESULTS: We included 497 patients (median age: 40 years,73% women), among whom 42 (8.5%, 95%CI:6-11%) had ocular fundus abnormalities. Of these 42 patients, 12 had disc edema, 9 had optic nerve pallor, 6 had grade III/IV hypertensive retinopathy, and 15 had isolated retinal hemorrhages. Body mass index ?35 (odds ratio[OR]:2.3, p=0.02), younger age (OR:0.7 per 10-year increase, p=0.02), and higher mean arterial blood pressure (OR:1.3 per 10 mmHg increase, p=0.003) were predictive of abnormal fundus photography. Patients with an abnormal fundus had a higher percentage of hospital admission (21% vs. 10%, p=0.04). Among the 34 patients with abnormal ocular fundi who had brain imaging, 14 (41%) had normal imaging.

Conclusions CONCLUSIONS: Ocular fundus abnormalities were found in 8.5% of headache patients presenting to our ED. Predictors of abnormal funduscopic findings included higher body mass index, younger age, and higher blood pressure. Our study confirms the importance of funduscopic examination in headache patients, particularly in the ED, and reaffirms the utility of non-mydriatic fundus photography in this setting.

Authors/Disclosures
Beau B. Bruce, MD, FAAN (Centers for Disease Control & Prevention) PRESENTER	Dr. Bruce has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Bayer.
Christopher Goetz, MD, FAAN (Rush University Medical Center)	The institution of Dr. Goetz has received research support from Michael J. Fox Foundation. The institution of Dr. Goetz has received research support from NIH. The institution of Dr. Goetz has received research support from Department of Defense. Dr. Goetz has received publishing royalties from a publication relating to health care. Dr. Goetz has received publishing royalties from a publication relating to health care. Dr. Goetz has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
Valerie Biousse, MD	Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Topcon. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.
	No disclosure on file
Nancy J. Newman, MD, FAAN (Emory University School of Medicine)	Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Phelcom. The institution of Dr. Newman has received research support from GenSight. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care.

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