University of Melbourne, Melbourne, Vic., Australia.
University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia.
Eur J Neurol. 2022 Aug;29(8):2463-2472. doi: 10.1111/ene.15390. Epub 2022 May 31.
Although fundoscopy is a crucial part of the neurological examination, it is challenging, under-utilized and unreliably performed. The aim was to determine the prevalence of fundus pathology amongst neurology inpatients and the diagnostic accuracy of current fundoscopy practice compared with systematic screening with smartphone fundoscopy (SF) and portable non-mydriatic fundus photography (NMFP).
This was a prospective cross-sectional surveillance and diagnostic accuracy study on adult patients admitted under neurology in an Australian hospital. Inpatients were randomized to initial NMFP (RetinaVue 100, Welch Allyn) or SF (D-EYE) followed by a crossover to the alternative modality. Images were graded by neurology doctors, using telemedicine consensus neuro-ophthalmology NMFP grading as the reference standard. Feasibility parameters included ease, comfort and speed.
Of 79 enrolled patients, 14.1% had neurologically relevant pathology (seven, disc pallor; one, hypertensive retinopathy; three, disc swelling). The neurology team performed direct ophthalmoscopy in 6.6% of cases and missed all abnormalities. SF had a sensitivity of 30%-40% compared with NMFP (45.5%); however, it had a lower rate of screening failure (1% vs. 13%, p < 0.001), a shorter examination time (1.10 vs. 2.25 min, p < 0.001) and a slightly higher patient comfort rating (9.2 vs. 8/10, p < 0.001).
Our study demonstrates a clinically significant prevalence of fundus pathology amongst neurology inpatients which was missed by current fundoscopy practices. Portable NMFP screening appears more accurate than SF, whilst both are diagnostically superior to routine fundoscopic practice, feasible and well tolerated by patients.
眼底检查虽然是神经科检查的重要组成部分，但操作难度大、利用率低且可靠性差。本研究旨在确定神经内科住院患者眼底病变的患病率，以及与常规眼底镜检查相比，当前眼底镜检查实践、智能手机眼底镜检查（SF）和便携式免散瞳眼底照相（NMFP）的系统筛查在诊断准确性方面的差异。
这是一项在澳大利亚一家医院神经内科住院患者中进行的前瞻性横断面监测和诊断准确性研究。患者被随机分为初始 NMFP（RetinaVue 100，Welch Allyn）或 SF（D-EYE）组，然后交叉至另一组。使用远程医疗共识神经眼科 NMFP 分级作为参考标准，由神经科医生对图像进行分级。可行性参数包括操作的简便性、舒适性和速度。
在纳入的 79 例患者中，有 14.1%（7 例存在视盘苍白、1 例存在高血压性视网膜病变、3 例存在视盘肿胀）存在与神经相关的病理学改变。神经科医生在 6.6%的情况下进行了直接检眼镜检查，且均漏诊了所有异常。SF 的敏感性为 30%-40%，略低于 NMFP（45.5%）；但 SF 的筛查失败率较低（1%比 13%，p＜0.001），检查时间更短（1.10 分钟比 2.25 分钟，p＜0.001），患者舒适度评分略高（9.2 比 8/10，p＜0.001）。
本研究表明，神经内科住院患者中存在显著的眼底病变患病率，而当前的眼底镜检查实践可能会漏诊这些病变。便携式 NMFP 筛查似乎比 SF 更准确，而这两种方法都优于常规眼底镜检查，且患者易于接受。
