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AM Carlsson, M ten Hove, F Stockl; The Direct Funduscopic Examination In General Practice: Is Diagnostic Yield Improved With A Mydriatic Agent? . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3468.
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Purpose: To determine whether tropicamide 0.5% improves diagnostic yield during direct funduscopic examination of the posterior pole by primary care practitioners Methods: Ten patients were selected from the eye clinics at Queen's University. A mixture of thirteen eyes with various retinal and optic nerve pathology and seven normal eyes made up the group. Ten residents from the Family Medicine and Emergency Medicine programs at Queen's University were selected randomly. None were familiar with the enrolled patients. All examiners had previously received both theoretical and practical training with the direct ophthalmoscope during their medical training. No additional instruction was given prior to the study. Each patient was situated in a separate examination room under identical seating and lighting conditions. Under strictly timed and controlled conditions, examiners were asked to examine the fundus of each patient with the direct ophthalmoscope and record their findings on a standardized assessment sheet. This process was repeated after the patients' pupils were dilated with 0.5% tropicamide. The diagnostic accuracy of their findings was compared for pre-dilation and post-dilation examinations. The patient parameters of pupil size and intraocular pressure measurements were also analyzed. Subjective examiner preference of pre-dilation versus post-dilation was also analyzed. Finally, during their assessment of the patients, a masked assessment of each examiner's technique was carried out and analyzed. Results: True negatives (correct identification of normal eyes) and true positives (correct identification of abnormal eyes) were tabulated for both the pre-dilation and post-dilation groups. In the non-dilated examination group diagnostic accuracy was 35% (60/171), while in the dilated examination group diagnostic accuracy was improved to 53% (91/171) (p = 0.000052 with the paired T-test). 100% of examiners found the dilated examination preferable to the non-dilated examination. 67% of examiners demonstrated good technique with direct ophthalmoscopy. Conclusion: Tropicamide 0.5% significantly increases a non-specialized examiner's ability to identify pathology of the posterior pole and facilitates completion of the ocular examination.
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