Duffield Stuart, Yan Kevin Y, Alencastro Landim George, Pendley Andrew M, Shanmugam Nithya, McHenry Jessica G, Adamkiewicz Daniel V, Vo Duyen T, Prosky Jordan, Keadey Matthew T, Wright David W, Dattilo Michael, Fischer Andrew F, Lin Mung Yan, Newman Nancy J, Biousse Valérie
Emory University School of Medicine, Atlanta, GA, USA.
Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
Neurohospitalist. 2025 Sep 23:19418744251382689. doi: 10.1177/19418744251382689.
Examination of the ocular fundus is part of the neurologic examination. However, bedside ophthalmoscopy is rarely performed, especially in emergency departments (EDs), with risk of delayed diagnoses and inappropriate triage. Our goal was to determine how often funduscopic examination using non-mydriatic ocular fundus photography combined with optical coherence tomography (NMPF-OCT) is possible and useful in a consecutive cohort of patients with neurologic/neurosurgical disorders evaluated in a general ED.
This was a quality improvement project, prospective over 16 consecutive days/nights. NMFP-OCT was ordered for all patients presenting to our ED with any neurologic/neurosurgical disorders. Demographic information, neurologic diagnoses, presence of headache and NMFP-OCT findings were collected.
Over 1838 ED visits, 448 (24.4%) patients reported neurologic complaints, including headache, or a history of neurologic disorders, of which 246 (54.9%) received NMFP-OCT imaging. Papilledema was ruled out for 233/246 patients with images, and abnormal ocular fundus findings were found in 29/246 (11.8%) patients, 22/29 with acute neurological complaints, 3/29 with isolated headache, and 4/29 with a history of neurologic/neurosurgical disorders. Findings included papilledema (9), other optic disc edema (3), optic atrophy (11), retinopathies (4), and other (2).
NMFP-OCT obtained in the ED in neurologic/neurosurgical patients allowed for rapid and reliable diagnosis of ocular fundus pathology in 11.8% of patients, confirming that NMFP-OCT is useful in patients with neurologic/neurosurgical disorders. However, 43% patients could not have NMFP-OCT, many due to illness severity, reinforcing the need for in-person funduscopic examination in some neurology/neurosurgery patients unable to have imaging.
眼底检查是神经科检查的一部分。然而，床边检眼镜检查很少进行，尤其是在急诊科，存在诊断延迟和分诊不当的风险。我们的目标是确定在综合急诊科评估的连续队列的神经科/神经外科疾病患者中，使用非散瞳眼底摄影联合光学相干断层扫描（NMPF-OCT）进行眼底检查的频率和实用性。
这是一项质量改进项目，连续16个日/夜进行前瞻性研究。对所有因任何神经科/神经外科疾病就诊于我们急诊科的患者进行NMPF-OCT检查。收集人口统计学信息、神经科诊断、头痛情况和NMPF-OCT检查结果。
在1838次急诊科就诊中，448例（24.4%）患者报告有神经科症状，包括头痛或神经科疾病史，其中246例（54.9%）接受了NMPF-OCT成像。在246例有图像的患者中，233例排除了视乳头水肿，29例（11.8%）患者发现眼底异常，29例中有22例有急性神经科症状，3例有孤立性头痛，4例有神经科/神经外科疾病史。检查结果包括视乳头水肿（9例）、其他视盘水肿（3例）、视神经萎缩（11例）、视网膜病变（4例）和其他（2例）。
在神经科/神经外科患者的急诊科获得的NMPF-OCT能够快速可靠地诊断11.8%患者的眼底病变，证实NMPF-OCT对神经科/神经外科疾病患者有用。然而，43%的患者无法进行NMPF-OCT检查，许多是由于病情严重，这凸显了在一些无法进行成像检查的神经科/神经外科患者中进行亲自眼底检查的必要性。
