Abstract
Purpose: :
To determine the frequency and cost of unnecessary diagnostic tests ordered by referring physicians and optometrists prior to neuro-ophthalmology evaluation.
Methods: :
The authors retrospectively reviewed the records of 85 patients referred for neuro-ophthalmologic evaluation between January 1, 2008 and March 31, 2008 to determine the frequency and cost of unnecessary diagnostic testing ordered by the referring provider. Pre-referral diagnostic testing costs were compared with the cost of neuro-ophthalmologic consultation for five common problems: (1) optic neuropathy; (2) diplopia; (3) ptosis; (4) proptosis; and (5) anisocoria.
Results: :
Of the 85 patients who met inclusion criteria, 59% (n=50) of patients had at least one pre-referral imaging study done. Of these 50 patients, 46% (n=23) were subjected to unnecessary testing. Additionally, four patients who were worked up correctly were subject to substandard neuro-imaging.
Conclusions: :
For neuro-ophthalmologic problems, prompt referral for subspecialty evaluation appears to be the most cost-effective strategy.
Keywords: optic nerve • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • neuro-ophthalmology: optic nerve