Nonmydriatic ocular fundus imaging helps diagnose ocular conditions in ED

The availability of nonmydriatic colour fundus photography (NMFP) with optical coherence tomography (OCT) in the emergency department (ED) enables quick diagnoses of ocular emergencies that usually involve the posterior segment, reports a study.

Adult patients who sought treatment at a general ED with any vision symptom and underwent NMFP-OCT from 24 August 2024 through 8 September 2024 were included in this prospective quality improvement study. The researchers then collected demographic information, final diagnosis, and NMFP-OCT findings.

A total of 1,838 ED visits were recorded over 16 days and nights. Of these, 182 patients (9.9 percent) reported vision symptoms, with 162 (89 percent) undergoing NMFP-OCT in the ED. Eighty-two of the 162 patients (50.6 percent) also had an in-person ED examination by an ophthalmologist.

Ocular imaging was ordered for the following: vision loss (n=51, 31.5 percent), other visual changes (n=13, 8.0 percent), papilledema or rule out papilledema (n=60, 37.0 percent), painless red eye (n=7, 4.3 percent), eye or orbital pain (n=28, 17.3 percent), and diplopia (n=3, 1.9 percent).

Of the patients who underwent NMFP-OCT, 104 (64.2 percent) showed relevant findings, while 31 (19.1 percent) had incidental findings.

Ocular imaging proved most useful in posterior segment disorders (n=45, 27.8 percent) and neurologic disorders (n=72, 44.4 percent), either by showing the abnormalities (ie, acute retinal ischaemia: n=5, 3.1 percent; optic disc edema: n=14, 8.6 percent; retinal detachment or vitreous haemorrhage: n=3, 1.9 percent; posterior uveitis, retinitis, or vasculitis: n=3, 1.9 percent; and retinopathy or maculopathy: n=9, 5.6 percent) or by ruling out papilledema (n=52, 32.1 percent).

“Given that 10 percent 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 researchers said.