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Nonmydriatic Ocular Fundus Photography in Neurologic Emergencies

Beau B. Bruce, MD, PhD1,2,3; Valérie Biousse, MD1,2; Nancy J. Newman, MD1,2,4
[+] Author Affiliations
1Department of Ophthalmology, Emory University, Atlanta, Georgia
2Department of Neurology, Emory University, Atlanta, Georgia
3Department of Epidemiology, Emory University, Atlanta, Georgia
4Department of Neurological Surgery, Emory University, Atlanta, Georgia
JAMA Neurol. 2015;72(4):455-459. doi:10.1001/jamaneurol.2014.4053.
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Importance  The ocular fundus examination is infrequently and poorly performed in clinical settings, placing patients at risk for missed and delayed diagnosis of vision- and life-threatening neurologic disease.

Objectives  To review the importance of ocular fundus examination, the limitations of direct ophthalmoscopy, and the relative merits of nonmydriatic ocular fundus photography in emergency neurologic diagnosis.

Evidence Review  PubMed queries were reviewed for articles of relevance to this review. Queries included relevant combinations of the search terms ophthalmoscopy, nonmydriatic, neurology, and emergency, including variant spellings and endings.

Findings  Nonmydriatic ocular fundus photography is more sensitive than direct ophthalmoscopy in several settings. It can be feasibly performed in emergency departments and has substantial promise in improving neurologic diagnosis, particularly headache and cerebrovascular disease.

Conclusions and Relevance  Nonmydriatic ocular fundus photography has notable advantages over direct ophthalmoscopy that likely outweigh its associated costs. More widespread deployment and integration into neurologic practice is expected to improve diagnosis and patient outcomes.

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Figure.
Nonmydriatic Ocular Fundus Photographs

A, Normal ocular fundus, with inset showing typical field of view of a direct ophthalmoscope. B, Optic disc edema. C, Optic disc pallor. D, Isolated retinal hemorrhage (arrowhead). E, Grade III hypertensive retinopathy (black arrowhead indicates cotton wool spot; white arrowhead, hemorrhage). The black backgrounds of the original images were cropped, and the brightness and contrast were adjusted.

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