To improve resident fundoscopy skills from comparison of direct handheld fundoscopy with retinal photography. By removing the technical challenges of direct ophthalmoscopy, residents will learn and confirm key ophthalmologic findings. Patient care will improve by allowing improved recognition of emergent fundoscopic findings, assisting the decision to order appropriate imaging, and identifying patients that require ophthalmology referral.

A complete neurologic examination includes the fundoscopic examination. Timely diagnosis of certain retinal abnormalities, especially papilledema, is crucial as they may reflect indicate serious neurologic disorders as well as potentially vision-threatening conditions. However, direct fundoscopic exam is often difficult, even for skilled neurologists. Nonmydriatic ocular fundus photography allows direct visualization of the ocular fundus with high-quality photographs.

New neurology resident clinic patients had fundoscopic photos taken at the time of triage. Images were uploaded to the hospital’s imaging software. Residents completed the neurologic exam as usual, including the fundoscopic exam with a handheld ophthalmoscope. Residents received immediate feedback and teaching when they analyzed the retina photos when staffing patients with their attendings. Comparison between findings on direct fundoscopy and retinal photos were analyzed and how subsequent evaluations were affected.

Retinal photography allowed identification of multiple abnormalities, including early papilledema, increased C/D ratios, optic atrophy, and several other abnormalities which were not appreciated on direct fundoscopy. Improved patient care resulted with changes in subsequent evaluations and ophthalmology referrals. Study results will be presented as the study remains in progress.

Fundus photography improves care in patients presenting with headache, vision symptoms, and focal neurologic findings. Its benefits are clear when one considers the high risk of negative patient outcomes and possible medicolegal consequences due to missed findings, the ease of incorporating retinal photographs into the medical records, and the benefit of improving resident education in regard to the ophthalmologic exam.