"Acute Vision Loss" in Patients Presenting to a Large Emergency Department: Impact of a Hybrid Non-Mydriatic Ocular Fundus Camera With Optical Coherence Tomography

The chief complaint of "acute vision loss" in the emergency department (ED) may reveal serious ocular and neurologic diagnoses requiring immediate evaluation. However, evaluation of such patients is often delayed and ED stays prolonged because ophthalmologists on-call are typically not on-site, frequently simultaneously covering multiple facilities. We implemented a hybrid nonmydriatic ocular color fundus camera combined with optical coherence tomography (NMFP-OCT) in our large general ED with the goal of facilitating rapid diagnosis of ocular emergencies and avoiding in-person consultations when the examination is normal. We hypothesize that incorporating NMFP-OCT into the workflow of a large general ED, combined with a list of triage questions for "acute vision loss", will facilitate rapid identification of ocular emergencies (e.g., acute central retinal artery occlusion [CRAO]), and reduce length of stay in the ED.

447 “Acute Vision Loss” In Patients Presenting To A Large Emergency Department: Impact Of A Hybrid Non-Mydriatic Ocular Fundus Camera With Optical Coherence Tomography Mariam Torres Soto 1, Mariana Rodriguez Duran 2, Andrew M. Pendley 3, Gabriele Berman 4, James Greene 5, David W. Wright 3 , Nancy J Newman 1, Valérie Biousse 1 Emory University School of Medicine, 2 Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, 3 Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA,, 4 Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK, 5 Emory University 1 Introduction: The chief complaint of “acute vision loss” in the emergency department (ED) may reveal serious ocular and neurologic diagnoses requiring immediate evaluation. However, evaluation of such patients is often delayed and ED stays prolonged because ophthalmologists on-call are typically not on-site, frequently simultaneously covering multiple facilities. We implemented a hybrid nonmydriatic ocular color fundus camera combined with optical coherence tomography (NMFP-OCT) in our large general ED with the goal of facilitating rapid diagnosis of ocular emergencies and avoiding in-person consultations when the examination is normal. We hypothesize that incorporating NMFP-OCT into the workflow of a large general ED, combined with a list of triage questions for "acute vision loss”, will facilitate rapid identification of ocular emergencies (e.g., acute central retinal artery occlusion [CRAO]), and reduce length of stay in the ED. Methods: Quality improvement project with prospective data collection for all patients undergoing NMFP-OCT in the ED for “acute vision loss”. Data collected: demographic information, indications for photographs, timing of photographs, ophthalmology consultations triggered, final diagnoses, lengths of stay, and final outcomes. Results: 16 weeks after implementation of NMFP-OCT, among 400 patients with NMFP-OCT, 87 patients presented with “acute vision loss” (including 15 CRAO, 11 retinal detachment, 7 vitreous hemorrhage, 5 papilledema, 5 uveitis, 5 optic neuritis). All these patients received in-person ophthalmology consultations confirming the diagnoses after NMFP-OCT showed abnormalities. Conclusions: The high prevalence of consultations for “acute vision loss” in our general ED suggests that incorporating NMFP-OCT into the workflow of the ED, combined with a list of triage questions for "acute vision loss”, could increase efficiency in the ED by accelerating the diagnosis using remote interpretation of ocular imaging prior to in-person consultation. Further data will be collected and results of the first 9 months (estimated >200 consecutive patients with “acute vision loss”) will be presented at the NANOS meeting. References: None provided. Keywords: Neuroimaging, Diagnostic tests (ERG, VER, OCT, HRT, mfERG, etc) Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: Mariam Torres Soto, [e-mail] 2024 Annual Meeting Syllabus | 601