Emergency Department Non-Mydriatic Fundus Photography Expediates Care For Patients Referred For “Papilledema”

Abstract

Purpose : Fear of missing neurologic disorders or visual loss from unrecognized papilledema often leads to Emergency Department (ED) visits for “papilledema“ rule-out and workup. Our institution implemented an ED “papilledema protocol” which took a median of 27 hours (IQR, 19-33) in 20221. We subsequently installed a non-mydriatic hybrid color fundus camera/OCT (NMFP/OCT) [Topcon Maestro2] in 06/2023 in our ED with the goal to improve patients’ outcomes and reduce length of stay. Our aim was to evaluate whether the NMFP/OCT could avoid in-person ED ophthalmology consultations and accelerate the evaluation of “papilledema" in the ED.

Methods : Prospective evaluation of consecutive adult patients presenting to our ED for “papilledema” rule-out/workup who had NMFP/OCT obtained in the ED from 06/09/2023-09/23/2023. We collected referral questions, final diagnoses, ED length-of-stay and whether an in-person ophthalmology consultation was performed in addition to remote interpretation of images. We compared ED length-of-stay with data prospectively collected in 2022 prior to installation of the camera in the ED.

Results : Compared to 27 hours (IQR, 19-33; 84 patients) in 2022, the ED NMFP/OCT reduced the median ED length-of-stay to 18 hours (IQR, 8-28; 104 patients) for patients referred to the ED for “papilledema”. For the 62 patients in whom papilledema was ruled-out by NMFP/OCT, the ED length-of-stay decreased from 15 hours (IQR, 8-26) in 2022 to 10 hours (IQR, 7-24) in 2023; papilledema was ruled out remotely without in-person ophthalmology consultation in 59/62 patients. For patients with previously known IIH, ED-stay decreased from 22hours in 2022 (IQR, 11-28) to 12 hours in 2023 (IQR, 7-32; 26 patients).

Conclusions : Implementation of NMFP/OCT in our general ED significantly reduced the ED length-of-stay of “papilledema” patients by 33%, and consistently avoided in-person ophthalmology consultations when papilledema was ruled-out remotely on ocular imaging. This confirms the feasibility and cost-effectiveness of implementing NMFP/OCT in the ED. Results of the first 8 months will be presented at the ARVO meeting

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