title: Feasibility of nonmydriatic ocular fundus photography in the emergency department: Phase I of the FOTO-ED study.
abstract: OBJECTIVE
  Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by nonophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of nonmydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs).
  
  
  METHODS
  Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mm Hg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a nonmydriatic fundus camera. Photographs were reviewed by a neuroophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of nonmydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems.
  
  
  RESULTS
  A total of 350 patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high-quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] = 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient's total ED visit.
  
  
  CONCLUSIONS
  Nonmydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by nonphysician staff, is well-received by staff and patients, and requires a trivial amount of time to perform.
authors: Department of Ophthalmology, Emory University, Atlanta, GA, USA. bbbruce@emory.edu
authors: Beau B
authors: BB
authors: Bruce
authors: Cédric
authors: C
authors: Lamirel
authors: Valérie
authors: V
authors: Biousse
authors: Antionette
authors: A
authors: Ward
authors: Katherine L
authors: KL
authors: Heilpern
authors: Nancy J
authors: NJ
authors: Newman
authors: David W
authors: DW
authors: Wright
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005128:Eye Diseases / Q000175:diagnosis*; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D009184:Mydriatics; D009722:Nurse Practitioners; D009887:Ophthalmoscopy / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010781:Photography; D010820:Physicians; D011446:Prospective Studies
chemical_list: D009184:Mydriatics