Purchase this article with an account.
C. Lamirel, B. B. Bruce, D. W. Wright, A. Ward, N. J. Newman, V. Biousse; Feasability of Non-Mydriatic Fundus Photography in the Emergency Department (ED). Invest. Ophthalmol. Vis. Sci. 2010;51(13):5468.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
There is ample evidence that fundus photography with pupillary dilation is a useful screening tool in ophthalmology. However, pupillary dilation is impractical in the ED. Non-mydriatic photography offers an alternative approach but has not been applied to the ED setting and is more challenging. Our objective was to determine the feasability of non-mydriatic fundus photography taken by nurse practitioners (NPs) for screening of neuro-ophthalmic emergencies in the ED.
Interim analysis of 309/350 consecutive planned patients photographed by NPs during their ED shift. Nurses received less than 30 minutes of fundus photography training. Photographs were taken of both eyes of each patient in a triage area in ambient or partially obscured lighting conditions. Nurses rated their impression of the ease and speed of obtaining photographs on each patient on a 10 point Likert scale (10 best). Patients similarly rated their impression of the comfort, ease, and speed. Time of arrival, photographs, and discharge were recorded. The photographs were reviewed by two neuro-ophthalmologists. Quality was graded from 1 to 5 (1: inadequate for any diagnostic purpose, 2: unable to exclude all emergent findings, 3: only able to exclude emergent findings, 4: not ideal but still able to exclude subtle findings, 5: ideal quality). Four regions were independently evaluated for quality: (1) optic disc, (2) macula, (3) superior and (4) inferior vascular arcades. Frequency of high quality images (grade 4 or 5) and inter-observer agreement were calculated.
NPs and patients were generally very pleased with non-mydriatic fundus photography (mean rating >8.7 for all scales), and typical photography sessions represented a trivial portion of a patient’s overall ED visit (median: 2.3 minutes). 260/309 (84%) had at least one eye with a high quality photograph, 177 (57%) had high quality pictures of both eyes, and 10 patients (3%) had no photograph of diagnostic value. The inter-observer agreement among the 2 neuro-ophthalmologists was very good (kappa 0.89 [95%CI:0.82-0.96]). Agreement between the NPs and the neuro-ophthalmologists was moderate (kappa 0.44 [0.35-0.53]). Quality of optic disc region was better than the quality of the other regions.
Fundus photography could be implemented within the ED workflow without adding a significant burden to nurses or patients. The quality of non-mydriatic fundus photography obtained by NPs in a clinical ED setting is adequate to assess neuro-ophthalmic emergencies, particularly changes of the optic disc.
Clinical Trial: :
This PDF is available to Subscribers Only