Shanmugam Nithya, Benard-Seguin Etienne, Arepalli Sruthi, Alencastro George, McHenry Jessica G, Rodriguez Duran Mariana, Torres Soto Mariam, Pendley Andrew M, Wright David W, Newman Nancy J, Biousse Valérie
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Telemed J E Health. 2025 Feb;31(2):185-190. doi: 10.1089/tmj.2024.0435. Epub 2024 Sep 30.
Ocular emergencies are commonly evaluated in general emergency departments (ED) where ophthalmologists are rarely available. Nonmydriatic ocular imaging combining color fundus photographs and optical coherence tomography (NMFP-OCT) can help with rapid remote triage by ophthalmologists. We evaluated the rate at which retinal detachments (RDs) can be diagnosed with NMFP-OCT in the ED. Quality improvement project with prospective collection of data on RD patients who had NMFP-OCT obtained by ED staff over 1 year. Photographs were interpreted remotely by ophthalmologists and all patients underwent an in-person ophthalmologic examination in the ED to confirm the presence of a RD. A total of 63 eyes (58 patients) had a RD, among which 53 (84.1%) had strong suggestion of RD on ocular imaging (34 [54%] were seen on both color and OCT nerve/macula; 11 [17.5%] were seen on color but missed on OCT; 8 [12.7%] were missed on color but seen on OCT). Ten RDs (15.9%) were missed on both color and OCT because of peripheral location of the RD (4, 40%), vitreous hemorrhage (4, 40%), or poor image quality (2, 20%). A total of 40 out of 58 patients were not seen by an eye care provider prior to reaching our ED and 10 had an inappropriate stroke workup for acute vision loss of presumed vascular origin. NMFP-OCT of the posterior pole obtained by ED staff revealed the RD in 84.1% of eyes, allowing for rapid remote triage of patients with visual symptoms and avoiding unnecessary testing when the diagnosis of RD is confirmed.
眼部急症通常在普通急诊科进行评估，而那里很少有眼科医生。结合彩色眼底照片和光学相干断层扫描的非散瞳眼部成像（NMFP - OCT）有助于眼科医生进行快速远程分诊。我们评估了在急诊科通过NMFP - OCT诊断视网膜脱离（RD）的比率。这是一项质量改进项目，前瞻性收集了1年多来急诊科工作人员为RD患者进行NMFP - OCT检查的数据。照片由眼科医生远程解读，所有患者在急诊科都接受了眼科当面检查以确认是否存在RD。共有63只眼（58例患者）发生了RD，其中53只眼（84.1%）在眼部成像时有强烈的RD提示（34只眼[54%]在彩色照片和OCT神经/黄斑检查中均可见；11只眼[17.5%]在彩色照片中可见但在OCT检查中漏诊；8只眼[12.7%]在彩色照片中漏诊但在OCT检查中可见）。10例RD（15.9%）在彩色照片和OCT检查中均漏诊，原因是RD位于周边部位（4例，40%）、玻璃体出血（4例，40%）或图像质量差（2例，20%）。58例患者中共有40例在到达我们的急诊科之前未接受眼科护理人员的诊治，10例因假定血管源性急性视力丧失而接受了不适当的卒中检查。急诊科工作人员获取的后极部NMFP - OCT在84.1%的眼中显示了RD，这使得能够对有视觉症状的患者进行快速远程分诊，并在确诊RD时避免不必要的检查。
