Fundus Imaging in Emergency Care Settings Cuts Down on Neuro-ophth Consults

Implementing nonmydriatic fundus imaging in an ED setting has significantly mitigated the increasing neuro-ophthalmology consultation burden, which, in many cases, forgoes the need for in-person consultation when imaging is normal—such as ruling out papilledema. Photo: Saidivya Komma, OD. Click image to enlarge. In a recent study, researchers sought to determine if the burden of emergency department (ED) and inpatient neuro-ophthalmology consultations has continued to increase over time and explore ideas that might alleviate the caseload for ED physicians. In a single-site study of patient volume at an academic medical center in an urban setting, researchers found a 78% increase in total consultations in just two years (2022 to 2024), but also found that a sizable number of in-person consults were avoided since the institution added nonmydriatic fundus imaging in its ED. The findings were reported in Ophthalmology.A systematic collection of consecutive ED and inpatient neuro-ophthalmology consultations at one academic center in 2024 was compared to results with data prospectively obtained during the year 2022. (A combined fundus camera/OCT was installed in 2023). In 2022, there were a total of 494 neuro-ophthalmology consultations requested by general ED and inpatient services.This increased by 78%, to 877 cases, in 2024.The most common reasons for ED visits were concern for papilledema, other optic disc swelling and optic neuritis, and 84% of emergency patients 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 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 or because known papilledema was stable or improved on remote review of ocular imaging. The proportion screened remotely rather than referred represents 28% of the 877 cases seen in 2024.With emergency medicine providers and neurology consultants able to review images on-site, allowing for rapid identification of papilledema or ruling out the condition, it has expedited the initiation of papilledema evaluation or discharge from the ED. The authors noted it has also enabled ultrarapid diagnosis of acute retinal artery ischemia, which opens the door to early treatments such as thrombolysis.In their paper, the researchers point out that non-mydriatic fundus imaging “has become a reliable and invaluable diagnostic aid for on-site ophthalmology evaluation (for both neuro-ophthalmology and general ophthalmology consultations) by increasing confidence for on-call ophthalmologists, preventing diagnostic errors and reducing the need to transport all consultation patients to the eye clinic.”In conclusion, these findings help make the case for adding ocular imaging tools to emergency care facilities to aid in remote interpretation and triage, especially for ruling out papilledema, thereby reducing the burden of in-person consultations.Click here for the journal source. Yan Lin M, Dattilo M, Pendley AM, et al. Neuro-ophthalmology consultations in an academic medical center with an emergency department equipped with non-mydriatic fundus imaging. Ophthalmology. August 21, 2025. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.