Related Experiment Video
Updated: Jan 19, 2026
Using Point of Care Ultrasound to Augment Acquisition of Physical Exam Skills: Organs
Published on: April 30, 2023
Retinal exams requested at Primary Care Unit: indications, results and alternative strategies of evaluation
Fernando Korn Malerbi1, Adriano Biondi Monteiro Carneiro1, Marcelo Katz1
1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Objective:
To evaluate indications, results and strategy of retinal exams requested at Primary Care Units.
Methods:
A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters.
Results:
A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams.
Conclusion:
Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.
Related Concept Videos
15:58Using Point of Care Ultrasound to Augment Acquisition of Physical Exam Skills: Organs
Point of care ultrasound (POCUS) is used by clinicians for diagnosis, ongoing monitoring, and/or procedural guidance at the time of patient care. Many medical schools are now teaching POCUS as a part of their basic clinical skills training, in addition to history, physical exams, and clinical reasoning. Besides being an independent skill, POCUS is also an incredibly useful tool for augmenting the teaching and learning of the...
13:11Sensory Exam
A complete sensory examination consists of testing primary sensory modalities as well as cortical sensory function. Primary sensory modalities include pain, temperature, light touch, vibration, and joint position sense. Sensation of the face is discussed in the videos Cranial Nerves Exam I and II, as are the special senses of smell, vision, taste,...
08:42Using Point of Care Ultrasound to Augment Acquisition of Physical Exam Skills: Veins and Arteries
Vascular diseases make up most cases of emergency hospitalization and carry a high mortality risk. Point-of-care ultrasound or POCUS enables accurate diagnosis of these diseases and shortens the time between detection of the cause and selection of appropriate treatment strategies, thus, reducing the patient mortality rate. POCUS offers a safe, low-cost, and less invasive bedside tool for examining arteries and veins, besides its...
09:51Using Point of Care Ultrasound to Augment Acquisition of Physical Exam Skills: Knee and Shoulder
Point of Care Ultrasound or POCUS is easy to use, has enhanced mobility due to the smaller equipment needed, and may be carried out in a variety of settings. It is also far safer and cheaper than imaging techniques like computer tomography.
POCUS can be helpful when certain physical exam findings are difficult to appreciate by palpation, percussion, or auscultation and can facilitate learning elements of the cardiac, pulmonary,...
05:21General Approach to the Physical Exam
The examination of the body is fundamental to the practice of medicine. Since the Roman Empire, physicians have described the connection between alterations in function of specific parts of the body and specific disease states and have sought to further scientific understanding to improve bedside diagnosis. However, in this modern age of increasing technology within medical diagnostics, it...
07:39Cardiac Exam I: Inspection and Palpation
The cardiac assessment is one of the core examinations performed by almost every physician whenever encountering a patient. Disorders of the cardiac system are among the most common reasons for hospital admission, with conditions ranging from myocardial infarction to congestive heart failure. Learning a complete and thorough cardiac examination is therefore crucial for any practicing...