Neuro-ophthalmology Consultations in an Academic Medical Center with an Emergency Department Equipped with Nonmydriatic Fundus Imaging.

Abstract

To compare our institution's emergency department (ED) and inpatient neuro-ophthalmology consultation patterns from 2024 (after implementation of nonmydriatic ocular imaging in our general ED) with the 494 neuro-ophthalmology consultations seen in 2022 (before implementation of the camera). Prospective observational study. Consecutive patients undergoing ED or inpatient neuro-ophthalmology consultations at a single, large, urban academic medical center. Systematic collection of consecutive ED and inpatient neuro-ophthalmology consultations at 1 academic center in 2024 and comparison of results with data prospectively obtained during 2022. Collected data included reason for consultation, final diagnoses, and whether an in-person ophthalmology consultation was performed in addition to remote interpretation of images. To determine if the burden of ED and inpatient neuro-ophthalmology consultations has continued to increase over time and evaluate the impact of nonmydriatic ocular imaging in the ED. Of 636 consecutive in-person neuro-ophthalmology consultations requested in 2024, 432 consultations (68%) were in the ED, and 204 consultations (32%) were in inpatient settings. The most common reasons for neuro-ophthalmology consultations in the ED were concern for papilledema, other optic disc swelling, and optic neuritis. Eighty-four percent of patients seen as in-person ED consultations underwent nonmydriatic ocular imaging. The most common reasons for inpatient consultations were concern for papilledema, visual field defects, and diplopia. During the same period, 241 additional patients who underwent nonmydriatic ocular imaging in the ED did not need in-person consultations either because papilledema was ruled out remotely on ocular imaging in 220 patients or because known papilledema was stable or improved on remote review of ocular imaging in 21 patients with known intracranial hypertension. In 2022, 494 neuro-ophthalmology consultations were requested by our general ED and inpatient services. This 2-point comparison suggests an increase in total neuro-ophthalmology consultations at our academic medical center, with 36% of in-person consultations avoided since implementation of nonmydriatic ocular fundus imaging in our ED. Implementation of nonmydriatic fundus cameras with teleophthalmology capabilities in the ED setting will be critical to address the increasing need for neuro-ophthalmic care by allowing remote consultations. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.