From the Departments of Ophthalmology (V.B., B.B.B., N.J.N.), Neurology (V.B., B.B.B., N.J.N.), Epidemiology (B.B.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine, Atlanta, GA.
Neurology. 2018 Jan 23;90(4):167-175. doi: 10.1212/WNL.0000000000004868. Epub 2017 Dec 22.
Although the usefulness of viewing the ocular fundus is well-recognized, ophthalmoscopy is infrequently and poorly performed by most nonophthalmologist physicians, including neurologists. Barriers to the practice of ophthalmoscopy by nonophthalmologists include not only the technical difficulty related to direct ophthalmoscopy, but also lack of adequate training and discouragement by preceptors. Recent studies have shown that digital retinal fundus photographs with electronic transmission and remote interpretation of images by an ophthalmologist are an efficient and reliable way to allow examination of the ocular fundus in patients with systemic disorders such as diabetes mellitus. Ocular fundus photographs obtained without pharmacologic dilation of the pupil using nonmydriatic fundus cameras could be of great value in emergency departments (EDs) and neurologic settings. The Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study showed that ED providers consistently failed to correctly identify relevant ocular funduscopic findings using the direct ophthalmoscope, and that nonmydriatic fundus photography was an effective alternate way of providing access to the ocular fundus in the ED. Extrapolating these results to headache clinics, outpatient neurology clinics, and adult and pediatric primary care settings seems self-evident. As technology advances, nonmydriatic ocular fundus imaging systems will be of higher quality and more portable and affordable, thereby circumventing the need to master the use of the ophthalmoscope. Visualizing the ocular fundus is more important than the method used. Ocular fundus photography facilitates nonophthalmologists' performance of this essential part of the physical examination, thus helping to reestablish the value of doing so.
虽然眼底检查的作用已得到广泛认可，但大多数非眼科医生（包括神经科医生）很少进行且不擅长进行这项检查。非眼科医生进行眼底检查的障碍不仅包括直接检眼镜检查相关的技术难度，还包括缺乏足够的培训以及带教医生的劝阻。最近的研究表明，通过电子传输数字视网膜眼底照片，并由眼科医生远程解读图像，是一种有效且可靠的方法，可用于检查患有糖尿病等全身性疾病的患者的眼部情况。使用非散瞳眼底相机在未进行散瞳的情况下获得的眼底照片在急诊科和神经科环境中可能具有重要价值。眼底摄影与眼科检查在急诊科的结果试验（FOTO-ED）表明，急诊科医生始终未能使用直接检眼镜正确识别相关的眼底检查结果，而非散瞳眼底摄影是在急诊科获取眼底的有效替代方法。将这些结果推断至头痛诊所、门诊神经科诊所以及成人和儿科初级保健机构似乎是不言而喻的。随着技术的进步，非散瞳眼部眼底成像系统将具有更高的质量、更高的便携性和更低的成本，从而避免了掌握检眼镜使用的需要。观察眼底比使用的方法更重要。眼底摄影使非眼科医生能够进行这项体检的重要部分，从而有助于重新确立进行此项检查的价值。
