The use of retinal photography in non-ophthalmic settings and its potential for neurology

• Authors: Mario A. Perez, Emory University; Beau Benjamin Bruce, Emory University; Nancy J Newman, Emory University; Valerie Biousse, Emory University
• Journal Title: Neurologist
• Volume: Volume 18, Number 6
• Publisher: Lippincott, Williams & Wilkins | 2012-11, Pages 350-355
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/NRL.0b013e318272f7d7
• Subjects: Health Sciences, Opthamology
• Keywords: direct ophthalmoscopy; retinal photography; fundus camera; telemedicine

Abstract

Background Ocular fundus examination is an important element of the neurological examination. However, direct ophthalmoscopy is difficult to perform without pupillary dilation and requires extensive practice to accurately recognize optic nerve and retinal abnormalities. Recent studies have suggested that digital retinal photography can replace direct ophthalmoscopy in many settings. Review Summary Ocular fundus imaging is routinely used to document and monitor disease progression in ophthalmology. Advances in optical technology have made it easier to obtain high-quality retinal imaging, even without pupillary dilation. Retinal photography has a high sensitivity, specificity, and inter-/intra-examination agreement compared to in-person ophthalmologist examination, suggesting that photographs can be used in lieu of ophthalmoscopy in many clinical situations. Non-mydriatic retinal photography has recently gained relevance as a helpful tool for diagnosing neuro-ophthalmologic disorders in the emergency department. Additionally, several population-based studies have used retinal imaging to relate ophthalmic abnormalities to the risk of hypertension, renal dysfunction, cardiovascular mortality, subclinical and clinical stroke, and cognitive impairment. The possibility of telemedical consultation offered by digital retinal photography has already increased access to timely and accurate subspecialty care, particularly for underserved areas. Conclusion Retinal photography (even without pupillary dilation) has become increasingly available to medical fields outside of ophthalmology, allowing for faster and more accurate diagnosis of various ocular, neurologic and systemic disorders. The potential for telemedicine may provide the additional benefits of improving access to appropriate urgent consultation in both clinical and research settings.