Abstract
Purpose :
Fundoscopy is a valuable tool for triaging patients with potential ocular and neurologic emergencies when complete ophthalmologic exam is not immediately available. This exploratory cross-sectional study was performed to assess the utility of non-mydriatic smartphone-assisted direct ophthalmoscopy in evaluating patients for optic nerve head elevation (ONHE).
Methods :
Patients requiring ophthalmologic examination to evaluate for ONHE in the emergency room, hospital, or clinic were enrolled. Patients with known anterior or posterior segment pathology were excluded. Non-mydriatic videos of the ONH were obtained by medical students with a D-Eye smartphone ophthalmoscope. Use of opioid medications was documented. A masked attending ophthalmologist reviewed the videos for quality as well as presence of ONHE, and the results were compared to those of an in-person clinical exam.
Results :
Non-mydriatic optic nerve videos of 30 eyes were collected over 6 months. Three videos were excluded because of insufficient visualization, 1 from an irregular pupil and 2 due to nystagmus. Of the 27 videos reviewed, 22 (81.5%) were of adequate quality. Comparison of the adequate videos to the clinical exam demonstrated 4 true positives (TP), 14 true negatives (TN), 1 false positive (FP) and 3 false negatives (FN). Clinical exams corresponding to all FN results demonstrated mild ONHE. Clinical exams corresponding to all TP results were significant for moderate or severe ONHE. Five videos were inadequate because of glare, eye movement or an incomplete view of the disc rim. Several inadequate videos were repeated post-dilation, which enhanced video quality. Fourteen videos were obtained from patients receiving opioids; 7 (50%) were rated as adequate, compared to 15 (93.8%) adequate videos obtained from patients not on opioids.
Conclusions :
This study supports the utility of smartphone-assisted fundoscopy to evaluate for ONHE, and provides further evidence that telemedicine may help triage ophthalmologic emergencies. Results from this study suggest that smartphone fundoscopy is able to accurately diagnose moderate to severe ONHE, but may be limited in its ability to detect mild ONHE. Opioid use may limit the ability to obtain adequate videos. Dilation may be necessary when the view is limited by poor patient cooperation or environmental challenges such as glare.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.