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Ryan K. Wong, John J. Huang; Assessment of Basic Eye Function Prior to Requesting Ophthalmology Consultation. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1400.
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Exposure to ophthalmology is limited in medical schools and many post-graduate training programs such as primary care and pediatric residencies. As a result many non-ophthalmologist physicians may be inadequately trained in the initial management or appropriate referral of ophthalmic disease. The purpose of this study was to characterize the rate and accuracy of basic ophthalmic assessment performed by the emergency department or inpatient services that requested ophthalmology consultation in a large teaching hospital.
All ophthalmology housestaff at Yale New Haven Hospital, who are responsible for initial evaluation of consultations, were asked to inquire about the primary service’s (emergency department or inpatient service) assessment of visual acuity (VA), extraocular movement (EOM), and pupillary function. A review of records from September 2010 to February 2011 was then performed to indentify charts that had documented this information. The primary service’s assessment of VA was compared to that performed by the ophthalmology service.
Of 613 emergency department and inpatient consultations performed by the ophthalmology service, 205 (33%) had documentation of the primary service’s initial ophthalmic assessment of VA, EOM, and pupillary exam. Of these 205 consultation requests 72 (35%) had assessed VA, 140 (68%) assessed EOM, and 148 (72%) assessed pupillary function prior to calling the ophthalmology service. Of the 72 cases that had assessed VA, 34 (47%) were qualitative measurements such as "intact" or "blurry." Of the 38 cases that quantitatively assessed VA, 23 (61%) had assessments that were worse than the VA eventually measured by the ophthalmology service.
Many emergency department and inpatient services do not assess VA, EOM, or pupillary function prior to requesting ophthalmology consultation. Additionally, the reported VA is often worse than that measured by the ophthalmology service. These findings may have important implications on the appropriate utilization of limited medical resources. Furthermore, the findings suggest possible areas of improvement in medical school and non-ophthalmology residency education.
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