Abstract
Purpose :
While ophthalmology-related emergency department (ED) visits are increasing, common ophthalmic consultations in high volume emergency settings primarily involve lower acuity diagnoses.1 This study aims to investigate the frequency of abnormal ophthalmic exam findings among ophthalmology consults in the ED setting.
Methods :
This cross-sectional study reviewed medical records of patients who received an ophthalmology consult in the ED at Harborview Medical Center (HMC), an academic tertiary care hospital and level 1 trauma center in Seattle WA, from January 1 to December 31, 2022. Demographics, ICD-10 codes, and exam findings including visual acuity, pupillometry, intraocular pressure, confrontational visual field, and extraocular movements were extracted from the electronic medical records and analyzed in Microsoft Excel.
Results :
Our data includes 1,189 patients and 1,241 ophthalmology consults of whom 67 (5.4%) had more than one ED consult visit. 58% were male and 42% were female, with an average (SD) age of 48.7 (18.6). A total of 1,144 pupillary exams were performed and an afferent pupillary defect (APD) was present in 120 (10.5%), not present in 991 (86.6%), questionable in 33 (2.9%), and not reported for 97 exams. Non-reactive pupils were observed in 152 (12.7%). The average (SD) intraocular pressure (IOP) was 15.9 (6.2) mmHg for the left eye and 15.8 (6.1) mmHg for the right eye. A total of 1,104 extraocular movement exams were performed, and deficits were noted in either eye in 6.9% of cases, both eyes in 1.5%. A total of 825 visual field exams were performed, and deficits were present in 112 (13.5%) of cases, with 51 (6.2%) affecting the left eye, 61 (7.3%) the right eye, and 5 (0.6%) homonymous defects. Right visual acuity was 20/40 or better in 62.8%, 20/50-20/150 in 17.2%, 20/200 - count fingers (CF) in 11.2%, hand motion (HM) in 4.7%, light perception (LP) in 2.4%, and no light perception (NLP) in 1.7%. Left visual acuity was 20/40 or better in 63.4%, 20/50-20/150 15.9%, 20/200-CF 12.4%, HM in 3.9%, LP in 1.8%, and NLP in 2.5%.
Conclusions :
This single-institution study provides a comprehensive report of ophthalmic findings of patients presenting to the ED of an academic tertiary care hospital and Level 1 trauma center in Seattle WA in 2022. This data can be used to guide the implementation of ophthalmic screening tools by providing pre-test probabilities for ocular abnormalities in a high acuity setting.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.