Shanmugam Nithya, Lin Mung Yan, McHenry Jessica G, Yan Kevin Y, Duffield Stuart, Pendley Andrew M, Alencastro Landim George, Adamkiewicz Daniel V, Vo Duyen T, Prosky Jordan, Keadey Matthew, Wright David W, Dattilo Michael, Newman Nancy J, Biousse Valérie
From the Department of Ophthalmology (N.S., M.Y.L., J.G.M., K.Y., S.D., G.A.L., D.V.A., J.P., M.D., N.J.N., V.B.), Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Emergency Medicine (A.M.P., D.T.V., M.K., D.W.W.), Emory University School of Medicine, Atlanta, Georgia, USA.
Am J Ophthalmol. 2026 Jan;281:126-137. doi: 10.1016/j.ajo.2025.09.016. Epub 2025 Sep 15.
To investigate the feasibility of systematic ocular imaging of consecutive patients presenting to our emergency department (ED) with chief complaints for which ocular funduscopic examination is standard of care.
Prospective quality improvement feasibility project.
Consecutive patients presented to our general ED fulfilling one or more of the following criteria: current vision complaints, headaches, neurologic/neurosurgical disorders, hypertensive crisis, diabetes mellitus, or end-stage renal disease.
Study personnel acquired table-top nonmydriatic ocular fundus photographs with optical coherence tomography of the posterior pole (NMFP-OCT) on consecutive patients presenting to our ED over 16 consecutive days/nights with complaints that would warrant an ophthalmology evaluation, including vision complaints, headaches, neurologic/neurosurgical disorders, hypertensive crisis, diabetes mellitus, or end-stage renal disease.
Demographic information, indication for NMFP-OCT, findings, quality of NMFP/OCT, number of NMFP-OCT, and reasons why NMFP-OCT were not taken were documented.
Among 1838 ED visits over 16 days, orders for NMFP-OCT were placed for 801 patients (43.6%). 410/801 patients (51%) received NMFP-OCT in the ED; 391/801 patients (49%) did not. 93/410 with NMFP-OCT (22.7%) vs 23/391 without NMFP-OCT (5.9%) had vision complaints (P < .001), 99/410 (24.1%) vs 35/391 (9%) had headaches (P < .001), 125/410 (30.5%) vs 164/391 (41.9%) had neurological/neurosurgical disorders (P < .05), 4/410 (1%) vs 4/391 (1%) had hypertensive crisis, and 76/410 (18.5%) vs 132/391 (33.8%) had diabetes. Demographics were similar in both groups. 220/391 patients (56.3%) did not have NMFP-OCT for medical reasons (47.3% too sick/unable to sit, 9% infectious precautions); 171/391 (43.7%) did not have NMFP-OCT because of process problems in the ED. Few ocular imaging studies (6.7%) was uninterpretable.
Despite 24/7 coverage of the ED by our team, 49% of patients did not have NMFP-OCT for reasons related to underlying patient illness or specific to the ED setting. Realistic expectations are needed when considering the feasibility of implementation of new ophthalmic technology in the ED.
探讨对因眼科眼底镜检查为标准诊疗手段的主要诉求而前来我院急诊科（ED）就诊的连续患者进行系统性眼部成像的可行性。
前瞻性质量改进可行性项目。
连续前来我院普通急诊科就诊且符合以下一项或多项标准的患者：当前视力问题、头痛、神经/神经外科疾病、高血压危象、糖尿病或终末期肾病。
研究人员在连续16天/夜期间，对因视力问题、头痛、神经/神经外科疾病、高血压危象、糖尿病或终末期肾病等需眼科评估的诉求前来我院急诊科就诊的连续患者，使用带后极部光学相干断层扫描的桌面式免散瞳眼底照相（NMFP - OCT）进行检查。
记录人口统计学信息、NMFP - OCT的指征、检查结果、NMFP/OCT的质量、NMFP - OCT的数量以及未进行NMFP - OCT的原因。
在16天内的1838次急诊科就诊中，为801例患者（43.6%）开具了NMFP - OCT检查单。410/801例患者（51%）在急诊科接受了NMFP - OCT检查；391/801例患者（49%）未接受检查。接受NMFP - OCT检查的410例患者中有93例（22.7%）存在视力问题，而未接受检查的391例患者中有23例（5.9%）存在视力问题（P < 0.001）；接受检查的患者中有99例（24.1%）头痛，未接受检查的患者中有35例（9%）头痛（P < 0.001）；接受检查的患者中有125例（30.5%）患有神经/神经外科疾病，未接受检查的患者中有164例（41.9%）患有神经/神经外科疾病（P < 0.05）；接受检查的患者中有4例（1%）发生高血压危象，未接受检查的患者中有4例（1%）发生高血压危象；接受检查的患者中有76例（18.5%）患有糖尿病，未接受检查的患者中有132例（33.8%）患有糖尿病。两组患者的人口统计学特征相似。391例未接受NMFP - OCT检查的患者中，220例（56.3%）是由于医疗原因（47.3%病情过重/无法坐立，9%出于感染防控措施）；171例（43.7%）未接受检查是由于急诊科的流程问题。很少有眼部成像检查（6.7%）无法解读。
尽管我们的团队对急诊科提供全天候服务，但仍有49%的患者因潜在的患者病情或急诊科特定情况而未接受NMFP - OCT检查。在考虑在急诊科实施新的眼科技术的可行性时，需要有现实的期望。
