Optic disc assessment in the emergency department: a comparative study between the PanOptic and direct ophthalmoscopes

Abstract

Optic disc assessment is an essential part of the neurological examination of acutely unwell patients. This study compares the PanOptic ophthalmoscope with the direct ophthalmoscope for accuracy of diagnosis and ease of use. Patient satisfaction was also compared for the two instruments. A single-masked prospective observational study was carried out. The authors showed that the PanOptic ophthalmoscope was more sensitive (p=0.03) and specific (p=0.03) than the direct ophthalmoscope. The PanOptic ophthalmoscope was preferred by both doctors (p=0.001) and patients (p=0.04) in terms of comfort and ease of use.

Nonmydriatic Fundoscopic Imaging Using the Pan Optic iExaminer System in the Pediatric Emergency Department

“…Fundoscopic examinations are an important component of the emergency department (ED) evaluation, especially in patients presenting with headache, altered mental status, trauma, hypertension, eye injury, or acute changes in visual acuity. Optic nerve edema is a particularly important examination finding in conditions that could result in increased intracranial pressure …”

“…Direct fundoscopy frequently requires a dilated pupil and dark environment to obtain a complete examination. Furthermore, successful fundoscopic visualization is dependent on the skills of the examiner due to its limited field of view . ED difficulties in performing a dilated eye examination are often due to time constraints and concerns for masking potentially important examination changes due to pupillary dilation .…”

“…Furthermore, successful fundoscopic visualization is dependent on the skills of the examiner due to its limited field of view . ED difficulties in performing a dilated eye examination are often due to time constraints and concerns for masking potentially important examination changes due to pupillary dilation . The traditional direct method is especially difficult to perform on the young pediatric patient who is less likely to cooperate with the examination .…”

“…The Pan Optic ophthalmoscope is a handheld instrument, much like the traditional direct ophthalmoscope. However, it provides an increased field of view (approximately 25 degrees vs. 5 degrees with the traditional direct ophthalmoscope), improving fundoscopic visualization in nondilated eyes . The design of the Pan Optic ophthalmoscope allows for the examiner to maintain a more comfortable working distance from the patient when compared to traditional direct fundoscopy .…”

Raised intracranial pressure in those presenting with headache

“…Instruments that might be easier to use than the standard direct ophthalmoscope include the PanOptic ophthalmoscope (Welch Allyn),9 and the Arclight, a pocket ophthalmoscope 10. Another option is fundus photography, using (for example) the Peek Retina, a smart phone attachment,11 or a non-mydriatic camera 12.…”