To evaluate the sustainability of a table-top non-mydriatic ocular fundus camera combining 45^°-true-color photographs and optical coherence tomography nerve/macula (NMFP-OCT) connected to our PACS/electronic health records in our general emergency department (ED).

We implemented ED-NMFP-OCT in 06/2023, ^1,2 and have shown that NMFP-OCT performed by ED-staff on patients with vision complaints,^3,4 headaches,⁵ neurologic disorders,⁶ hypertensive crisis,² with remote interpretation of imaging by ophthalmologists: prevented diagnostic errors;⁸ accelerated triage/patient’s discharge;⁷ reduced in-person ophthalmology consultations;^7,8 reduced burden/increased confidence among trainees.^1,7,8

Prospective quality improvement project with systematic collection of data on consecutive patients who underwent ED-NMFP-OCT from implementation on 6/14/2023-09/23/2025.

3692 patients received NMFP-OCT (average, 4.4/day), with increasing rate of 0.126 NMFP-OCT/week.

Images ordered by ED-providers for vision complaints (2518/3692;68%), headache (732/3692;20%), other neurologic (309/3692;8%), hypertensive crisis (43/3692;1%), diabetes mellitus (79/3692;2%), other (11/3692;0.3%). Papilledema was ruled-out remotely in 789/981 (80%) patients with concern for intracranial hypertension, avoiding in-person consultations in 93.

NMFP-OCT (performed by ED-staff in 89%) was of quality good enough for interpretation in 3256/3692 (88%).

1406/3692 (38%) NMFP-OCT were abnormal: papilledema (245/1406;17.4%); other optic neuropathies (365/1406;26%); CRAO/BRAO (82/1406;5.8%); uveitis/retinitis (115/1406;8.2%), retinal detachment (176/1406;12.5%); vitreous hemorrhage (96/1406;6.8%); other vitreous+retinal abnormalities (230/1406;16.4%); incidental findings (97/1406;6.9%).

Camera/connections required rare (<1/month) routine maintenance lasting <3hrs, mostly from automated EHR/PACS updates. 

>2 years after implementation in our busy ED, daily NMFP-OCT continues to increase, with ED providers routinely ordering NMFP-OCT based on standard-of-care recommendations for fundus examination. Workflows were adapted to incorporate systematic NMFP-OCT for all patients with vision complaints prior to in-person ophthalmology consultations, and specifically-created protocols [“EyeSTroke Alerts”,⁹ “Papilledema Concern/Evaluation”].^7,8

Our large prospective consecutive series confirms that ED-NMFP-OCT is sustainable, scalable, requiring minimal training for replicable use, efficacious for a wide variety of acute clinical presentations, continuing to improve patient care, patient outcomes, and trainee education, making its implementation desirable/likely feasible in other EDs.