Nonmydriatic Ocular Fundus Imaging on Consecutive Patients Seeking Treatment at a General Emergency Department with...

Visits to emergency departments (ED) for vision symptoms are common, especially where access to eye care may be limited. However, ophthalmologists rarely are available in EDs, resulting in costly and often unnecessary transfers. Implementation of nonmydriatic color fundus photography with OCT (NMFP-OCT) in general EDs may facilitate on-site ophthalmologic diagnoses and opens the door to teleophthalmology for remote triage and rapid treatment. Our goal was to evaluate which ocular symptoms and pathologic features would benefit most from NMFP-OCT in a general ED.

Prospective quality improvement study.

Adult patients seeking treatment at our general ED with any vision symptom who underwent NMFP-OCT in our ED from August 24, 2024, through September 8, 2024.

In this prospective quality improvement project over 16 consecutive days and nights, NMFP-OCT (Tabletop Maestro2; Topcon) was ordered for all patients seeking treatment in our ED with any vision symptom. Demographic information, final diagnosis, and NMFP-OCT findings were collected.

Number of patients with vision symptoms who underwent NMFP-OCT, number of in-person ophthalmology consultations, pathology identified.

Of 1838 ED visits over 16 days and nights, 182 patients (9.9%) reported vision symptoms; 162 patients (89%) underwent NMFP-OCT in the ED. Eighty-two of 162 patients (50.6%) also underwent an in-person ED examination by an ophthalmologist. Ocular imaging was ordered for vision loss (n = 51 [31.5%]), other visual changes (n = 13 [8.0%]), papilledema or rule out papilledema (n = 60 [37.0%]), painless red eye (n = 7 [4.3%]), eye or orbital pain (n = 28 [17.3%]), and diplopia (n = 3 [1.9%]). One hundred four of 162 patients (64.2%) showed relevant findings on NMFP-OCT; 31 of 162 patients (19.1%) showed incidental findings. Ocular imaging was most useful in posterior segment disorders (n = 45 [27.8%]) and neurologic disorders (n = 72 [44.4%]), either by demonstrating the abnormalities-such as acute retinal ischemia (n = 5 [3.1%]); optic disc edema (n = 14 [8.6%]); retinal detachment or vitreous hemorrhage (n = 3 [1.9%]); posterior uveitis, retinitis, or vasculitis (n = 3 [1.9%]); and retinopathy or maculopathy (n = 9 [5.6%])-or by ruling out papilledema (n = 52 [32.1%]).

Given that 10% of all ED visits were for vision symptoms, having NMFP--OCT available in our ED allowed for rapid and reliable diagnosis of ocular emergencies mostly involving the posterior segment, thereby facilitating rapid remote triage and treatment.

The author(s) have no proprietary or commercial interest in any materials discussed in this article.