Article

All eye complaints are not created equal: The value of hand-held retina camera in the Emergency Department

1518 Correspondence / American Journal of Emergency Medicine 36 (2018) 14971520

Lindsey Ouellette, MPH1

Sean Farley2 Justin Rieth2 Brad Riley, MD2 Bryan Judge, MD2 Jeffrey Jones, MD*

College of Human Medicine, Michigan State University, Department of Emergency Medicine Grand Rapids, United States Department of Emergency Medicine, Spectrum Health Hospitals, Grand

Rapids, United States

*Corresponding author at: 15 Michigan St NE Suite 701, Grand Rapids,

MI 49503, United States.

E-mail address: [email protected] (J. Jones).

3 January 2018

https://doi.org/10.1016/j.ajem.2018.01.018

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    1 15 Michigan St NE 736, Grand Rapids, MI 49503.

    2 15 Michigan St NE, Suite 701, MC 038, Grand Rapids, MI 49503.

    All eye complaints are not created equal: The value of hand-held retina camera in the Emergency Department

    Ophthalmologic complaints are among the more frequently encountered problems in the Emergency Department (ED). Complaints range from something as benign as viral pink eye to something much more concerning like acute Vision loss. Clearly, several of these chief complaints require Prompt diagnosis and Urgent treatment or specialty consult. Missed or delayed diagnosis can lead to complications and potential permanent loss of vision. In contrast to examination of the eye lids, conjunctiva and anterior chamber which can be easily evaluated by the ED physician, the examination of the fundus often proves extremely difficult. A funduscopic examination, especially in a busy ED and in the undilated eye requires experience and poses a significant challenge to the inexperienced physician with inadequate training in fundus examination [1]. It can be time consuming and cumbersome to dilate the eye and also inconvenient for the patient. Additionally, a noted disadvantage of direct funduscopic examination is that only the examiner has seen the pathology and the remainder of the physicians involved in the patient’s care must rely on the description of the exam by the primary examiner without having a photographic representation of the findings. For these reasons, direct ocular fundus examination is seldom adequately performed in a busy ED and it is often left to the ophthalmologist.

    A new tool that may prove helpful in the further management of concerning potentially dangerous eye complaints is the digital fundus camera [2-7]. A study by Bruce et al. showed improved diagnostic accu- racy using a digital fundus camera in the ED [2].

    We recently acquired a hand-held non-mydriatic retinal camera as well as anterior chamber camera (Pictor Plus from Volk Imaging). Our

    experience so far has been rewarding. The test requires minimum preparedness and training. Patients were informed about the test and verbal consent was obtained. No dilatation of the eye is required for the examination. Some of the findings we encountered were papilledema from Optic neuritis, macular degeneration, hypertensive and diabetic retinopathies of different degrees (Fig. 1). These results from funduscopic photography in combination with the history and the general physical examination helped in guiding the disposition as well as the need for specialty consult and treatment. Providers were eager to use the camera given the superior results they obtained compared to direct funduscopic examination. Another positive aspect of funduscopic imaging that we noted was its use as an educational tool for staff, with repeated improved visualization of the fundus and subsequent additional exposure to the different clinical scenarios. Its use also improved communication with consultants by allowing the provider to better visualize and describe fundus findings. Realizing that the majority of smaller hospitals do not have an “in house” ophthalmologist 24 h a day or their consulting ophthalmolo- gist must cover several hospitals and is not readily available for timely consult, these images obtained with funduscopic imaging can be uploaded to the patient’s chart electronically enabling their re- mote access by the consultant to provide recommendations in real time. These uploaded images also serve as a reference for comparison with future images and follow up of the Disease progression. The fundus camera also can be used as a screening tool for patients who miss their appointments in the eye clinic for diabetic eye screening. The screening or follow up examination can be performed when patients present to the ED for other complaints and the images be stored in medical records for review by ophthalmologist or primary care physician.

    Getaw Worku Hassen, MD, PhD*

    Roger Chirurgi, MD Jean-Paul Menoscal, MD Hossein Kalantari, MD, MPH

    NYMC, Metropolitan Hospital Center, Department of Emergency Medicine,

    New York, NY, United States

    *Corresponding author at: NYMC, Metropolitan Hospital Center, 1901 First Avenue, New York, NY 10029, United States.

    E-mail address: [email protected] (G.W. Hassen).

    3 January 2018

    https://doi.org/10.1016/j.ajem.2018.01.019

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    Lamirel C, et al. Quality of nonmydriatic digital fundus photography obtained by nurse practitioners in the emergency department: the FOTO-ED study. Ophthalmolo- gy 2012;119:617-24. https://doi.org/10.1016/j.ophtha.2011.09.013.

  4. Massin P, et al. Evaluation of a new non-mydriatic digital camera for detection of di- abetic retinopathy. Diabet Med 2003;20:635-41.
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  7. Vuong LN, et al. Ocular fundus photography of patients with focal neurologic deficits in an emergency department. Neurology 2015;85:256-62. https://doi.org/10.1212/ WNL.0000000000001759.

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