Nonmydriatic Ocular Fundus Photography in the Emergency Department

• Authors: Beau Benjamin Bruce, Emory University; Cedric Lamirel, Emory University; David W Wright, Emory University; Antionette Ward, Emory University; Kate L Heilpern, Emory University; Valerie Biousse, Emory University; Nancy J Newman, Emory University
• Journal Title: New England Journal of Medicine
• Volume: Volume 364, Number 4
• Publisher: Massachusetts Medical Society | 2011-01-27, Pages 387-389
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1056/NEJMc1009733
• Subjects: Health Sciences, Opthamology; Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Examination of the ocular fundus is imperative in the diagnosis and treatment of many acute medical and neurologic conditions, but direct ophthalmoscopy is underused and difficult to perform without pharmacologic pupillary dilation. We believe that nonmydriatic ocular fundus photography (i.e., performed without pupillary dilation) represents a promising alternative to direct ophthalmoscopy, particularly in the emergency department, where limited training in ophthalmoscopy, increased demands on physicians' time, and underappreciation of the prognostic value of ocular fundus examination can place patients at risk for poor outcomes and expose their caregivers to medicolegal liability. The FOTO-ED (Fundus Photography vs. Ophthalmoscopy Trial Outcomes in the Emergency Department) study hypothesized that the use of nonmydriatic fundus photography in the emergency department would result in increased detection of abnormalities in the ocular fundus relevant to emergency-department care, a majority of which would be missed during routine clinical practice in the department.