Utilization patterns for diagnostic imaging in the evaluation of epiphora due to lacrimal obstruction: a national survey.
OBJECTIVE
To evaluate current physician patterns for diagnostic lacrimal imaging in patients with epiphora related to lacrimal obstruction.


METHODS
An invitation was sent to members of the American Society of Ophthalmic Plastic and Reconstruction Surgeons in September 2008 to participate in a short web-based questionnaire. The survey focused on basic demographic information and the use and indications for various types of diagnostic imaging modalities in the evaluation of epiphora. Specific imaging modalities queried included facial x-ray, lacrimal ultrasound, CT, MRI, contrast dacryocystography, and radionuclide dacyroscintigraphy. Responses were analyzed using standard statistical methods.


RESULTS
Less than 5% of respondents use lacrimal imaging of any type for the majority of their patients with epiphora thought due to lacrimal obstruction. When lacrimal imaging was used, CT was the most common type overall. CT was the preferred modality for all indications surveyed when an imaging modality was elected, except when confirming the site or type of obstruction in which case dacryocystography was preferred. Excluding CT, a majority of respondents indicated that they "never" (0%) used any of the specific lacrimal imaging studies surveyed, including dacyroscintigraphy, which was never used by over 75% of respondents.


CONCLUSIONS
The low overall imaging rate suggests that most lacrimal problems are diagnosed with office testing alone. For most specific indications, respondents indicated a preference for CT. No difference in imaging frequency was found for the majority of our respondents when considering external versus endonasal dacryocystorhinostomy. Most respondents favored external approach dacryocystorhinostomy.
Nagi
Kundandeep S
KS
Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Albany (Slingerlands), New York 12159, USA.
Meyer
Dale R
DR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007765:Lacrimal Apparatus / Q000473:pathology*; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis / Q000209:etiology; D007767:Lacrimal Duct Obstruction / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D009885:Ophthalmology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012955:Societies, Medical / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States