The Urgency of Neuroimaging Among UK Neuro-Ophthalmologists: Consensus and Disagreement

The timing of imaging in neuro-ophthalmology is critical. There are few published studies, however, that address the question of how urgently to request imaging for neuro-ophthalmic clinical scenarios. We therefore conducted a national survey of expert opinion on the urgency of neuroimaging in neuro-ophthalmology. We devised a list of 40 clinical scenarios, reflecting a wide range of neuro-ophthalmic presentations. For each scenario, respondents were asked to state how urgently they would obtain neuroimaging in day-to-day NHS (National Health Service) practice. There were five response options: "Emergency" (i.e., within 1 d), "Urgent" (i.e., within 1 week), "Semi-urgent" (i.e., within 1 month), "Observation" (only if not resolving after a period of observation [greater than 1 month]), and "Not normally scanned unless new features appear." Respondents were recruited by e-mailing individuals who were on the UKNOSIG (UK Neuro-Ophthalmology Special Interest Group) mailing list. All were Consultant Ophthalmologists or Neurologists specialising in neuro-ophthalmology. Consensus was set at an a priori level of 80% agreement. Only 17 out of 40 scenarios met the criterion for consensus. Nine of these were for emergency/urgent imaging, three were for not imaging, and five were for semi-urgent imaging. For the remaining 23 scenarios, consensus was not reached. Unanimity (100% agreement) was not reached for any scenario. Agreement between neuro-ophthalmologists on the urgency of neuroimaging is patchy, with consensus for some clinical scenarios and disagreement for many. There is a need for a prospective study of neuroimaging in neuro-ophthalmology to determine whether timing of imaging influences outcomes.