The Use Of Fundus Photography In The Emergency Room-A Review

Abstract

Purpose of review: The ocular fundus reveals a wealth of pathophysiological findings which should change patient management in the emergency room (ER). Traditional fundoscopy has been technically challenging and diagnostically inaccurate, but technological advances in non-mydriatic fundus photography (NMFP) have facilitated clinically meaningful fundoscopy. This review presents an update on the literature regarding NMFP and its application to the ER, illustrating pivotal publications and recent advances within this field.

Recent findings: NMFP's application in the ER is demonstrably feasible and seamlessly integrates into emergency physicians' (EP) diagnostic workflows in a clinically meaningful and time efficient manner. The images of the ocular fundus (OF) generated by NMFP are consistently high quality, allowing a greater diagnostic accuracy to EP and ophthalmology interpreters alike. Digital NMFP images facilitate effective ophthalmology input via telemedicine to review the images in the ER. NMFP has been shown to change management decisions in the ER, improving patient and departmental outcomes. Interpretation of fundus images remains a medical education challenge, and early research highlights the potential for artificial intelligence (AI) image systems of NMFP to augment image interpretation in the ER. NMFP can change the ER approach to OF assessment, however the factors limiting its routine implementation need further consideration. There is potential for AI to contribute to NMFP image screening systems to augment EPs diagnostic accuracy.

Keywords: Diabetic retinopathy (DR); Direct ophthalmoscopy (DO); Emergency physician (EP); Emergency room (ER); Non-mydriatic fundus photography (NMFP); Ocular fundus (OF).