Visual Acuity and Intraocular Pressure Measurements Agreement between the Emergency Department and the Ophthalmology Service

Abstract

Purpose : Accurate visual acuity (VA) and intraocular pressure (IOP) measurements are paramount for appropriate triage of urgent ophthalmology consultations. This study assesses the agreement between VA and IOP measurements obtained by emergency department (ED) providers and ophthalmology services during ED visits for eye-related complaints.

Methods : This is a cross-sectional study of all patients presenting to the Harborview Medical Center, an academic tertiary care hospital and level 1 trauma center in Seattle, WA, with an eye-related complaint between February 1, 2022, and January 31, 2023, for which an ophthalmology consult was requested. Electronic medical records were reviewed to extract the VA and IOP in each eye obtained by the ED provider and from the same-day ophthalmology examination. All Snellen VA measurements were converted to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Intraclass Correlation Coefficient (ICC) with a 2-way random effects model was utilized to assess agreement between measurements.

Results : A total of 1462 patient charts were reviewed. The ED obtained VA for 53.6% of right eyes and 51.5% of left eyes. Ophthalmology recorded VA for 94.9% of right eyes and 94.3% of left eyes. Seven-hundred twenty-one right (49.3%) and 705 left eyes (48.2%) had VA measurements from both the ED and Ophthalmology. ICC of the VA measurements was 0.86 (95% CI: 0.84-0.88) for the right eye, and 0.88 (95% CI: 0.86-0.99) for the left eye (Table 1). The ED obtained numerical IOP readings in 39.3% of right eyes and 38.9% of left eyes, while Ophthalmology obtained IOP for 89.8% of right eyes and 89.3% of left eyes. Five-hundred thirty-one (36.3%) right eyes and 517 (35.3%) left eyes had IOP measurements from both the ED and Ophthalmology. ICC of IOP measurements was 0.59 (95% CI: 0.52-0.66) for the right eye, and 0.64 (95% CI: 0.58-0.70) for the left eye (Table 1). When both eyes were considered in combination, ICC was 0.87 (95% CI: 0.86-0.88) for VA, and 0.56 (95% CI: 0.50-0.61) for IOP (Table 1).

Conclusions : The agreement of VA measurements between the ED and Ophthalmology was acceptable, but agreement of IOP measurements was lower. There was a relatively low rate of completion of both basic eye examination components by the ED provider.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.