Non-Mydriatic Ocular Fundus Photography Read by Emergency Department (ED) Physicians: FOTO-ED Study (P07.264)

Abstract

Objective: Compare non-mydriatic ocular fundus photography read by ED physicians to their direct ophthalmoscopy. Background In the first phase of the FOTO-ED Study, 12.6% of 350 ED patients with complaints/conditions warranting ocular fundus examination had findings, such as papilledema, that should have altered their management/disposition. Disturbingly, only 14% of these 350 patients had direct ophthalmoscopy performed, and nearly all of the relevant findings were missed and identified solely by fundus photography reviewed by neuro-ophthalmologists. Design/Methods: Patients presenting to our ED with headache, focal neurologic defect, visual change, or diastolic blood pressure ≥120 were prospectively enrolled. Fundus photography was performed by a nurse practitioner or medical student using a non-mydriatic fundus camera (Kowa nonmyd-alpha-D). ED physicians were notified that photographs were available on the electronic medical record, but were not required to review the photographs. Results: 354 patients were included from among 473 assessed for eligibility (exclusions:82 ineligible, 33 refused participation, 3 other reasons). Photographs of 239 (68%) were reviewed by ED physicians. 34 patients (10%) had relevant findings identified by neuro-ophthalmologist review (6 disc edema, 6 grade III/IV HTN retinopathy, 6 isolated hemorrhages, 15 optic disc pallor, and 1 retinal vascular occlusion). 14 of those 34 relevant findings (41%) were identified by the ED physicians, eight (24%) occurred in patients whose photographs were not reviewed by ED physicians, and the remaining were reviewed but recorded as likely normal/normal. The ED physicians reported that the photographs were helpful for 125 patients (35%). Conclusions: Non-mydriatic fundus photographs were used more frequently than direct ophthalmoscopy by ED physicians, and were more sensitive to relevant abnormalities. Ocular fundus photography was more often helpful in ED patient evaluations, even when normal. We plan to investigate whether training in the interpretation of fundus photographs improves ED physician performance and facilitates appropriate ED management. Supported by: In part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, and by NIH/NEI core grant P30-EY06360 (Department of Ophthalmology). Dr. Bruce receives research support from the NIH/NEI (K23-EY019341). Dr. Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award. Disclosure: Dr. Bruce has nothing to disclose. Dr. Thulasi has nothing to disclose. Dr. Fraser has nothing to disclose. Dr. Keadey has nothing to disclose. Dr. Ward has nothing to disclose. Dr. Heilpern has nothing to disclose. Dr. Wright has received (royalty or license fee or contractual rights) payments from Emory University. Dr. Wright holds stock and/or stock options in Zenda Technologies. Dr. Newman has received personal compensation for activities with Biogen Idec. Dr. Biousse has nothing to disclose.