To determine if various digital fundoscopic devices (D-eye, iExaminer) will improve resident confidence and frequency of performing fundoscopic exam, and ultimately improve patient care.

Fundoscopic exams are often underutilized and inadequately performed, especially at a training level. Prior studies regarding introducing digital fundoscopy in the emergency room (ER) have shown increased detection of fundus pathologies by ER physicians.

One D-eye device and two iExaminer devices were made available to all neurology residents in July 2018 and an informal training session of the devices was provided. All current Neurology residents at our institution were asked to fill out a survey regarding their experience with direct (co-axial and pan-optic) vs. digital ophthalmoscopes after 5 months.

21 out of 40 residents responded to the initial survey. 75.2% of responders felt that overall training for fundoscopic exam in residency was inadequate, and a majority of them rarely or never performed fundus exams (57% outpatient, 81% inpatient). A majority of residents felt uncomfortable using traditional fundoscopy to visualize the fundus (81% co-axial vs. 52.4% pan-optic). After 5 months, only 23.8% felt comfortable using digital devices, with most common reasons being inexperience and difficulty with navigating the application on the iPhone. Using digital devices, residents were more often able to visualize the fundus clearly (81.8% digital vs. 57.1% direct) and identify pathologies (33% digital vs. 14.3% direct). The biggest reported challenge to performing fundoscopic exams was lack of training (81%).

Digital fundoscopy devices are easier to handle and help better visualize the fundus compared to traditional fundoscopes. However, lack of training and unfamiliarity with normal and pathologic fundus findings limit their use. Formal fundoscopy training should be provided during neurology residency to improve frequency of the exam and ultimately patient care.