Emergency department physicians should check certain patients for optic nerve head edema (ONHE) by fundus photography, researchers say.
“The FOTO-ED study showed that non-mydriatic retinal photography in the emergency department is feasible and may improve patient care and outcomes when systematically performed in patients with a chief complaint of headache, neurologic deficit, visual loss, or elevated blood pressure (BP). Finding ONHE is particularly important in this patient population,” the authors reported May 10 at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO), in Baltimore, Maryland.
“Optic nerve head edema is very serious and may represent life-threatening pathology. Fundus photography is feasible and detects clinically important pathology much better than standard ophthalmoscopy procedures. We think it is time for all EDs to begin to use fundus photography to evaluate patients,” co-author Dr. David W. Wright of Emory University School of Medicine in Atlanta, Georgia, told Reuters Health in an email.
“One in 40 patients (2.5%) presenting to the emergency department with a chief complaint of headache, neurologic deficit, visual loss, or elevated BP had ONHE. Our results are consistent with the hypothesis that the identification of ONHE altered the patient disposition and contributed to the final diagnosis, confirming the importance of funduscopic examination in the ED,” the authors wrote.
In the cross-sectional analysis of patients presenting to an urban academic emergency department in the United States, Dr. Wright and colleagues assessed the characteristics of the patients diagnosed with ONHE.
Of the 1,429 patients in the study, 36 (2.5%) had ONHE. Twenty-six of these patients presented with bilateral ONHE. The remaining 10 patients presented with unilateral ONHE.
The chief complaints among the patients with ONHE, irrespective of type, included: headache (n=18), acute visual deficit (n=2), acute neurological deficit (n=4), elevated blood pressure (n=2), and both headache and acute visual deficit (n=2).
Final diagnoses included idiopathic intracranial hypertension (n=18), optic neuritis (n=3), and cerebrospinal fluid shunt malfunction/infection (n=3). Two patients each suffered from a brain tumor, non-arteritic ischemic optic neuropathy, cerebral venous sinus thrombosis, or malignant hypertension. One patient each suffered from meningitis, cerebral infarction and neurosarcoidosis, or retinopathy.
Out of the 36 patients, 15 were seen in the emergency department and their referring physician had already diagnosed ONHE. In 21 patients, fundus photographs were the first indication of ONHE in the emergency department. However, the emergency department health care providers identified the presence of ONHE in just five patients. Perhaps most significant, however, was that knowledge of the presence of ONHE changed the final diagnosis in 10 of these patients.