Abstract Details

Title Replacing the Direct Ophthalmoscope: Diagnostic Accuracy and Use of Non-Mydriatic Ocular Fundus Photography by Emergency Department Physicians (Phase II of the FOTO-ED Study)

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) IN4 - (-)

Poster/Presentation
Number 001

Objective

Background During the first phase of the FOTO-ED Study, 13% of patients had an ocular fundus finding, such as papilledema, relevant to their emergency department (ED) management. All of these findings were missed by ED physicians, who only examined 14% of enrolled patients by direct ophthalmoscopy.

Design/Methods 354 patients presenting to our ED with headache, focal neurologic deficit, visual change, or diastolic blood pressure ?120 had non-mydriatic fundus photography obtained (Kowa nonmyd-alpha-D). Photographs were placed on the electronic medical record for review by ED physicians. Identification of relevant ocular fundus findings (defined a priori as optic disc edema, grade III/IV hypertensive retinopathy, isolated intraocular hemorrhages, optic disc pallor, and retinal vascular occlusion) on photographs by ED physicians was compared to a reference standard of review by neuro-ophthalmologists.

Results ED physicians reviewed the photographs of 239 patients (68%). 35 patients (10%) had relevant findings identified by neuro-ophthalmologist review (6 disc edema, 6 grade III/IV hypertensive retinopathy, 7 isolated hemorrhages, 15 optic disc pallor, and 1 retinal vascular occlusion). 16 of 35 relevant findings (46%) were identified by the ED physicians, eight (24%) occurred in patients whose photographs were not reviewed by ED physicians, and the remaining were missed on photographs reviewed but recorded as "likely normal" or "normal". The ED physicians reported that the photographs were helpful for 125 patients (35%).

Conclusions ED physicians used non-mydriatic fundus photographs more frequently than they perform direct ophthalmoscopy, and their detection of relevant abnormalities was improved. Ocular fundus photography often assisted with clinical decisions even when normal. Non-mydriatic ocular fundus photography offers a promising alternative to direct ophthalmoscopy.

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.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	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 $500-$4,999 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 Neurophth. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lilly. The institution of Dr. Newman has received research support from GenSight. The institution of Dr. Newman has received research support from Santhera. The institution of Dr. Newman has received research support from NINDS/NIH. 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.
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.
Teri Schreiner, MD, MPH, FAAN (University of Colorado/ Children's Hospital of Colorado)	The institution of Dr. Schreiner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CDC. Dr. Schreiner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. The institution of Dr. Schreiner has received research support from Roche Genentech.

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