Diagnostic accuracy of non-mydriatic fundus photography as a triage and telemedicine tool for patients with vision loss
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Chijindu A. Ukagwu
,
Joshua C. Teichman
Abstract
Objectives
Fundoscopy can be challenging for non-ophthalmologists. For emergency physicians, non-mydriatic fundus photography is superior to other forms of ophthalmoscopy in sensitivity, specificity, and inter-examination agreement. We report on a prospective cross-sectional study evaluating the use of non-mydriatic photography as a triage and telemedicine tool for patients with vision loss in a Canadian emergency setting.
Methods
Images of both eyes were obtained by a non-ophthalmologist using a handheld, non-mydriatic fundus camera and shared with a fellowship-trained ophthalmologist without patient context. The reviewer was asked to (1) select the best photo obtained for each eye and rate image quality on a Likert scale, (2) comment on the presence or absence of fundus abnormalities and (3) provide an opinion on whether findings would have changed patient disposition if available at the time of the initial Emergency Department (ED) exam.
Results
Of 57 patients evaluated in the ED for vision loss, 22.8 % had a documented fundus examination. 86.8 % of images were deemed to have acceptable quality (Likert scale≥2). Factors limiting image quality included media opacity, pupillary miosis, photosensitivity, and eyelid/periorbital abnormalities. Of patients with relevant abnormalities, 0 % were identified by emergency physicians. In contrast, 37.5 % of patients with relevant findings were identified on review of images alone (specificity=100 %).
Conclusions
Fundoscopy is infrequently performed in the emergency setting in patients presenting with vision loss. Non-mydriatic fundus photography is a cost-effective method of fundus examination for non-expert examiners and can be reliably used as a telemedicine tool for remote ophthalmology consultation.
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Research ethics: Ethics approval was obtained from the research ethics board at the academically affiliated tertiary care center at which the study was conducted on June 14, 2023. The document ID was ID#1156. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
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Articles in the same Issue
- Frontmatter
- Reviews
- Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis
- Prenatal screening for genetic disorders: updated guidelines, proposed counseling, a holistic approach for primary health care providers in developing countries
- A scoping review of fever of unknown origin with normal serum C-reactive protein
- Mini Review
- Overview of dengue diagnostic limitations and potential strategies for improvement
- Opinion Papers
- Demystifying cognitive bias in the diagnostic process for frontline clinicians and educators; new words for old ideas
- Physicians’ prism: illuminating history with structured expertise
- Original Articles
- Implementation of a curriculum on communicating diagnostic uncertainty for clerkship-level medical students: a pseudorandomized and controlled study
- A synthesized differential diagnosis is associated with fewer diagnostic errors compared to an inventorial list
- Equity-Driven Diagnostic Excellence framework: An upstream approach to minimize risk of diagnostic inequity
- Two decades of autopsy-detected diagnostic errors in Japan
- Does management reasoning display context specificity? An exploration of sleep loss and other distracting situational (contextual) factors in clinical reasoning
- Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths
- Racial and ethnic disparities in pediatric emergency department patients with missed opportunities for diagnostic excellence
- Diagnostic accuracy of non-mydriatic fundus photography as a triage and telemedicine tool for patients with vision loss
- “Innumerable” lesion burden on brain MRI ‒ a diagnostic approach
- Factors associated with positive findings of deep infection on computed tomography among patients with extremity cellulitis
- Exploring emergency department providers’ uncertainty in neurological clinical reasoning
- Analytical performance and user-friendliness of four point-of-care measuring systems for monitoring prothrombin time international normalized ratio in the hands of the intended users
- Fetal hematological phenotypes of various hemoglobinopathies and demonstration of embryonic hemoglobins on capillary electrophoresis: a large cohort data from prenatal screening program
- Development and assessment of autoverification system for routine coagulation assays in inpatient and outpatient settings of tertiary care hospital: algorithm performance and impact on laboratory efficiency
- Validation of new, circulating biomarkers for gliomas
- Short Communications
- Using language to evaluate curricular impact: a novel approach in assessing clinical reasoning curricula
- Comparative evaluation of routine coagulation testing on Stago sthemO 301 and Werfen ACL TOP 750
- Letters to the Editor
- Reversible systemic vasoconstriction syndrome: a new diagnostic family of generalized vasospasm in multiple organs
- The value of designating symptoms as “vague” in diagnosis
- Immunoglobulin E in an inverted skin-prick test for rapid detection of cutaneous antigens
