Michael Y Woo1, Nathan Hecht2, Bernard Hurley3, David Stitt2, Venkatesh Thiruganasambandamoorthy4. 1. Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont; Ottawa Hospital Research Institute, Ottawa, Ont. Electronic address: mwoo@toh.on.ca. 2. Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. 3. Department of Ophthalmology, University of Ottawa Eye Institute at the Ottawa Hospital. 4. Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont; Ottawa Hospital Research Institute, Ottawa, Ont; Department of Epidemiology and Community Medicine.
Abstract
OBJECTIVES: The objective of this study was to determine the test characteristics of point-of-care ultrasonography (POCUS) for the diagnosis of retinal tear (RT), retinal detachment (RD), posterior vitreous detachment (PVD), and vitreous hemorrhage (VH). DESIGN: A prospective observation study on a convenience sample of patients presenting to a tertiary care emergency general ophthalmology clinic was performed. PARTICIPANTS: Adult patients with acute flashes/floaters or new visual field defects were included (n = 62). METHODS: POCUS was performed by a study sonographer and compared with a retina specialist examination without sonography imaging. Sonographers were masked to clinical information. Follow-up was performed by a 6-week health records review. The primary outcome was the diagnosis of RD/RT, PVD, and VH. Analyses included descriptive statistics and test characteristics. RESULTS: A total of 62 patients with a mean age of 60.8 years were enrolled; 62.9% were female. The mean time to scan required was 7.4 minutes. There was no change in diagnosis at 6 weeks. The sensitivities and specificities, respectively, are as follows: any pathology (n = 60) 88.3% (95% CI 86.8%-89.9%) and 50% (95% CI 2.7%-97.3%); RD (n = 6) 100% (95% CI 53.9%-100%) and 67.9% (95% CI 62.9%-67.9%); RD/RT (n = 23) 47.8% (95% CI 30.8%-62.2%) and 82.1% (95% CI 72.0%-90.6%); PVD (n = 47) 80.9% (95% CI 74.7%-88.0%) and 33.3% (95% CI 14.0%-55.7%); and VH (n = 14) 43.0% (95% CI 21.4%-58.0%) and 93.8% (95% CI 87.5%-98.2%). CONCLUSIONS: Ocular POCUS detected all RDs but has limited use for the diagnosis of RTs. Patients with suspected acute ocular posterior pathology should be referred to ophthalmology independent of ocular POCUS.
OBJECTIVES: The objective of this study was to determine the test characteristics of point-of-care ultrasonography (POCUS) for the diagnosis of retinal tear (RT), retinal detachment (RD), posterior vitreous detachment (PVD), and vitreous hemorrhage (VH). DESIGN: A prospective observation study on a convenience sample of patients presenting to a tertiary care emergency general ophthalmology clinic was performed. PARTICIPANTS: Adult patients with acute flashes/floaters or new visual field defects were included (n = 62). METHODS: POCUS was performed by a study sonographer and compared with a retina specialist examination without sonography imaging. Sonographers were masked to clinical information. Follow-up was performed by a 6-week health records review. The primary outcome was the diagnosis of RD/RT, PVD, and VH. Analyses included descriptive statistics and test characteristics. RESULTS: A total of 62 patients with a mean age of 60.8 years were enrolled; 62.9% were female. The mean time to scan required was 7.4 minutes. There was no change in diagnosis at 6 weeks. The sensitivities and specificities, respectively, are as follows: any pathology (n = 60) 88.3% (95% CI 86.8%-89.9%) and 50% (95% CI 2.7%-97.3%); RD (n = 6) 100% (95% CI 53.9%-100%) and 67.9% (95% CI 62.9%-67.9%); RD/RT (n = 23) 47.8% (95% CI 30.8%-62.2%) and 82.1% (95% CI 72.0%-90.6%); PVD (n = 47) 80.9% (95% CI 74.7%-88.0%) and 33.3% (95% CI 14.0%-55.7%); and VH (n = 14) 43.0% (95% CI 21.4%-58.0%) and 93.8% (95% CI 87.5%-98.2%). CONCLUSIONS: Ocular POCUS detected all RDs but has limited use for the diagnosis of RTs. Patients with suspected acute ocular posterior pathology should be referred to ophthalmology independent of ocular POCUS.