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Ryan Wong, John Huang; Ophthalmology Consultation on Asymptomatic Patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4395.
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A recent study showed that a lack of ocular symptoms in the setting of fungemia correlated with a lack of fungal eye involvement in all cases, which could be a potentially useful prognostic factor in eliminating low yield ocular evaluations. Anecdotal evidence at our hospital suggests a similar trend not only in asymptomatic patients with fungemia, but also for other asymptomatic patients for which ophthalmology consultation is requested. The purpose of this study was to characterize the rate, utility, and cost of these ophthalmic consultations of asymptomatic patients.
A retrospective chart review was conducted on consecutive new patients from September 2010 to August 2011. Ophthalmology consultations on alert and orientated patients who had no ocular evidence or complaints were specifically collected.
80/1,399 (6%) alert and orientated patients underwent ophthalmology consultation despite having no signs or symptoms suggestive of ocular disease. The most common reasons for these consultations were to rule out ocular involvement with fungemia [17/80 (21%)] and to rule out papilledema [16/80 (18%)] (Table 1). Inpatient services demonstrated a significantly higher rate of consultation request of asymptomatic patients when compared to emergency services (Table 2; 12.4% vs. 1.2%, p<0.0001). Of all asymptomatic patients evaluated, one had findings (retinal flame hemorrhages) related to the reason for consultation, which was to assess for end-organ damage in a patient admitted for hypertensive crisis. Eighteen patients had incidental findings unrelated to reason for consultation. None of these patients had a change in management due to findings on ophthalmology consultation. The estimated total cost of these consultations, based on 2011 Medicare fees, was $16,685.
Our results suggest that ophthalmology consultations on alert, asymptomatic patients seem to have low diagnostic and therapeutic utility for hospital-based management. However, it should be noted that many incidental ophthalmic findings did occur that required routine, outpatient ophthalmologic follow-up, such as choroidal nevi and familial drusen. Additionally, an estimated cost of these consultations was relatively high.
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