Nonmydriatic Ocular Fundus Photography in the Emergency Department: How It Can Benefit Neurologists

Beau B. Bruce

doi:10.1055/s-0035-1563576

Seminars in Neurology, Table of Contents

Semin Neurol 2015; 35(05): 491-495
DOI: 10.1055/s-0035-1563576

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nonmydriatic Ocular Fundus Photography in the Emergency Department: How It Can Benefit Neurologists

Beau B. Bruce

¹Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia

²Department of Neurology, Emory University School of Medicine, Atlanta, Georgia

³Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Atlanta, Georgia

› Author Affiliations

Abstract

Examination of the ocular fundus is a critical aspect of the neurologic examination. For example, in patients with headache the ocular fundus examination is needed to uncover “red flags” suggestive of secondary etiologies. However, ocular fundus examination is infrequently and poorly performed in clinical practice. Nonmydriatic ocular fundus photography provides an alternative to direct ophthalmoscopy that has been studied as part of the Fundus Photography versus Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) Study. Herein, the results of the FOTO-ED study are reviewed with a particular focus on the study's implications for the acute care of patients presenting with headache and focal neurologic deficits. In headache patients, not only optic disc edema and optic disc pallor were observed as would be expected, but also a large number of abnormalities associated with hypertension. Based upon subjects with focal neurologic deficits, the FOTO-ED study suggests that the ocular fundus examination may assist with the triage of patients presenting with suspected transient ischemic attack. Continued advances in the ease and portability of nonmydriatic fundus photography will hopefully help to restore ocular fundus examination as a routinely performed component of all neurologic examinations.

Keywords

ocular fundus - headache - cerebrovascular disease - direct ophthalmoscopy - emergency

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References

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