Non-Mydriatic Ocular Fundus Imaging on Consecutive Neurologic and Neurosurgical Patients in an Emergency Department

Examination of the ocular fundus is part of the neurologic examination. However, bedside ophthalmoscopy is rarely performed, especially in emergency departments (EDs), with risk of delayed diagnoses and inappropriate triage. Our goal was to determine how often funduscopic examination using non-mydriatic ocular fundus photography combined with optical coherence tomography (NMPF-OCT) is possible and useful in a consecutive cohort of patients with neurologic/neurosurgical disorders evaluated in a general ED.

This was a quality improvement project, prospective over 16 consecutive days/nights. NMFP-OCT was ordered for all patients presenting to our ED with any neurologic/neurosurgical disorders. Demographic information, neurologic diagnoses, presence of headache and NMFP-OCT findings were collected.

Over 1838 ED visits, 448 (24.4%) patients reported neurologic complaints, including headache, or a history of neurologic disorders, of which 246 (54.9%) received NMFP-OCT imaging. Papilledema was ruled out for 233/246 patients with images, and abnormal ocular fundus findings were found in 29/246 (11.8%) patients, 22/29 with acute neurological complaints, 3/29 with isolated headache, and 4/29 with a history of neurologic/neurosurgical disorders. Findings included papilledema (9), other optic disc edema (3), optic atrophy (11), retinopathies (4), and other (2).

NMFP-OCT obtained in the ED in neurologic/neurosurgical patients allowed for rapid and reliable diagnosis of ocular fundus pathology in 11.8% of patients, confirming that NMFP-OCT is useful in patients with neurologic/neurosurgical disorders. However, 43% patients could not have NMFP-OCT, many due to illness severity, reinforcing the need for in-person funduscopic examination in some neurology/neurosurgery patients unable to have imaging.