Purchase this article with an account.
Adnan Mallick, David Fastenberg, Vincent Deramo; Are patients with retinal symptomatology over-imaged in the Emergency Room?. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1508.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To assess the Emergency Room (ER) management of patients with monocular visual complaints correlating with retinal pathology.
In this retrospective review, charts of 57 consecutive patients with monocular visual complaints were evaluated. Ophthalmology consults were called on these 57 patients by ER physicians from 3 hospitals in the Northwell Health system between 1/2014 to 3/2016. Patient demographics, past medical and ocular history, subjective complaints, ER physician exams, testing ordered prior to ophthalmology consultation, and ophthalmology exams were documented. Outpatient retinal photocoagulation and surgical procedures were also reviewed for patients requiring intervention by retinal specialists. Patients with binocular symptoms, or patients in whom workup was required for other systemic complaints were excluded.
57 patients were included with 31 females and 26 males, mean age of 59.2. Subjective complaints included monocular blurry vision in 32 patients (56%), shadows or visual field cuts in 15 patients (26%), floaters in 17 patients (30%), and flashes in 6 patients (11%). Among the 15 patients who had documented eye exams by ER physicians, 6 included confrontational visual field exams (40% of total ED exams). Prior to consultation by an on-call ophthalmologist, tests ordered by the ER included routine blood work in 19 patients (33%), computerized axial tomography (CT) of the head with or without orbits in 20 patients (35%), ultrasound of orbit by the ER physician in 2 patients (4%), magnetic resonance imaging (MRI head) in 1 patient (2%), and serum ESR/CRP in 1 patient (2%). Patient diagnoses included posterior vitreous detachment in 22 patients (39%), vitreous hemorrhage in 18 patients (32%), retinal detachment in 10 patients (18%), central retinal artery occlusion in 4 patients (7%), and central or branch retinal vein occlusions in 2 patients (3%). Of the 10 patients with retinal detachments, 3 patients (30%) underwent surgical repair within 1 week of examination.
In patients presenting to the ER with monocular visual complaints, over 30% underwent imaging studies as well as blood work prior to ophthalmology consultation. Signs and symptoms of retinal pathology should be recognized promptly. Proper triaging and timely consultations may lead to fewer imaging studies and more judicious management of time sensitive diagnoses.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only