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Ultrasound for diagnosing retinal detachment
Background: Retinal detachment is one of several sight-threatening conditions seen in the ED. Flashes and floaters are often the first sign that something is amiss, and the standard ED workup involves slit lamp examination and fundoscopy. However, subtle abnormalities are difficult to pick up on fundoscopy, especially in the non-dilated eye. In the FOTO-ED study (2011), ED physicians only performed fundoscopy in 33 out of 350 appropriate cases, and they missed the diagnosis in every one (confirmed by photos taken of the fundus at the time of examination).
Is there a better way to check the back of the eye? The first observational trial of ocular ultrasound in the ED (17 years ago in 2002) found it to be very accurate and since then many more trials have appeared. The average 'bench-to-bedside' period is often quoted as 17 years - has the time come for ocular ultrasound to become common practice?
Gottlieb M, Holladay D, Peksa GD. Point-of-care ocular ultrasound for the diagnosis of retinal detachment: a systematic review and meta-analysis. Acad Emerg Med 2019;00:1-9
The paper: A systematic review that found 11 observational studies with a total of 844 patients. Ocular ultrasound was performed by ED physicians on patients with suspected retinal detachment, and their findings were compared to final ophthalmology diagnosis. They found that ultrasound was 94.2% sensitive and 96.3% specific for the diagnosis of retinal detachment.
The bottom line: Ocular ultrasound is both sensitive and specific for the diagnosis of retinal detachment and, with training, is probably a better examination tool than fundoscopy for this condition.
Note: The Royal College of Ophthalmologists (2010) recommend immediate referral if the patient has "visual field loss or fundoscopic signs of detachment or vitreous haemorrhage". They recommend indirect ophthalmoscopy within 24 hours if there is "no visual field loss, normal visual acuity and normal fundoscopic exam" (i.e. reported flashes and floaters only)...
So where does ocular ultrasound fit into this? If your patient has normal visual acuity and no field deficit, perform ultrasound. If there are signs of detachment, refer them immediately; if not, they can be seen the following day.
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By Barrie StevensonBackground: Retinal detachment is one of several sight-threatening conditions seen in the ED. Flashes and floaters are often the first sign that something is amiss, and the standard ED workup involves slit lamp examination and fundoscopy. However, subtle abnormalities are difficult to pick up on fundoscopy, especially in the non-dilated eye. In the FOTO-ED study (2011), ED physicians only performed fundoscopy in 33 out of 350 appropriate cases, and they missed the diagnosis in every one (confirmed by photos taken of the fundus at the time of examination).
Is there a better way to check the back of the eye? The first observational trial of ocular ultrasound in the ED (17 years ago in 2002) found it to be very accurate and since then many more trials have appeared. The average 'bench-to-bedside' period is often quoted as 17 years - has the time come for ocular ultrasound to become common practice?
Gottlieb M, Holladay D, Peksa GD. Point-of-care ocular ultrasound for the diagnosis of retinal detachment: a systematic review and meta-analysis. Acad Emerg Med 2019;00:1-9
The paper: A systematic review that found 11 observational studies with a total of 844 patients. Ocular ultrasound was performed by ED physicians on patients with suspected retinal detachment, and their findings were compared to final ophthalmology diagnosis. They found that ultrasound was 94.2% sensitive and 96.3% specific for the diagnosis of retinal detachment.
The bottom line: Ocular ultrasound is both sensitive and specific for the diagnosis of retinal detachment and, with training, is probably a better examination tool than fundoscopy for this condition.
Note: The Royal College of Ophthalmologists (2010) recommend immediate referral if the patient has "visual field loss or fundoscopic signs of detachment or vitreous haemorrhage". They recommend indirect ophthalmoscopy within 24 hours if there is "no visual field loss, normal visual acuity and normal fundoscopic exam" (i.e. reported flashes and floaters only)...
So where does ocular ultrasound fit into this? If your patient has normal visual acuity and no field deficit, perform ultrasound. If there are signs of detachment, refer them immediately; if not, they can be seen the following day.