Test characteristics of point-of-care ultrasonography for the diagnosis of acute posterior ocular pathology

Woo, Michael Y.; Hecht, Nathan; Hurley, Bernard; Stitt, David M.; Thiruganasambandamoorthy, Venkatesh

doi:10.1016/j.jcjo.2016.03.020

Cited by 14 publications

(34 citation statements)

References 14 publications

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“…Studies were published between 1995 and 2018 with population sizes ranging from 32 to 139. Three studies were conducted in the United States, two were performed in Canada, one took place in China, one was conducted in India, one was performed in Ireland, one was conducted in Korea, one took place in Nigeria, and one was performed in Thailand . Five studies were conducted in the ED setting, two were performed in radiology departments, one was performed in an ophthalmology clinic, and three did not describe the study setting .…”

Section: Resultsmentioning

confidence: 99%

“…Three studies were conducted in the United States, two were performed in Canada, one took place in China, one was conducted in India, one was performed in Ireland, one was conducted in Korea, one took place in Nigeria, and one was performed in Thailand . Five studies were conducted in the ED setting, two were performed in radiology departments, one was performed in an ophthalmology clinic, and three did not describe the study setting . Emergency medicine providers performed the examination in six studies, radiologists performed the examination in four studies, and one study did not describe the provider specialty .…”

Section: Resultsmentioning

confidence: 99%

“…Five studies were conducted in the ED setting, two were performed in radiology departments, one was performed in an ophthalmology clinic, and three did not describe the study setting . Emergency medicine providers performed the examination in six studies, radiologists performed the examination in four studies, and one study did not describe the provider specialty . All studies used a linear probe except for Ukponmwan and Marchien, who used a curvilinear probe .…”

Section: Resultsmentioning

confidence: 99%

“…However, prior studies were limited by small sample sizes, resulting in wide ranges of potential accuracy . Since then, a number of additional studies have been published, significantly increasing the available data …”

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confidence: 99%

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Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Gottlieb

Holladay

Peksa

2019

Academic Emergency Medicine

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Background: Ocular complaints are common presentations to the emergency department (ED). Among these, retinal detachment can cause significant vision loss if not rapidly diagnosed and referred for appropriate treatment. Point-of-care ultrasound has been suggested to identify the diagnosis rapidly when the ocular examination is limited or the ophthalmology service is not readily available. However, prior studies were limited by small sample sizes, resulting in wide ranges of potential accuracy. The primary outcome for this review was to determine the test characteristics of point-of-care ocular ultrasound for the diagnosis of retinal detachment.Methods: PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all prospective and randomized controlled trials assessing the accuracy of point-of-care ultrasound for identifying retinal detachment. Data were dual extracted into a predefined worksheet and quality analysis was performed using the QUADAS-2 tool. Data were summarized and a meta-analysis was performed with planned subgroup analyses by location and provider specialty. This review was registered with PROSPERO CRD42018097288. There was no funding for this review.Results: Eleven studies (n = 844 patients) were identified. Overall, ultrasound was 94.2% (95% confidence interval [CI] = 78.4% to 98.6%) sensitive and 96.3% (95% CI = 89.2% to 98.8%) specific for the diagnosis of retinal detachment with a positive likelihood ratio of 25.2 (95% CI = 8.1 to 78.0) and a negative likelihood ratio of 0.06 (95% CI = 0.01 to 0.25). Subgroup analysis found that ultrasound was more accurate among ED patients, but was not significantly different when performed by ED or non-ED providers.Conclusions: Point-of-care ocular ultrasound is sensitive and specific for the diagnosis of retinal detachment.Future studies should determine the ideal training protocol and the influence of color Doppler and contrastenhanced ultrasound on diagnostic accuracy. O cular complaints are common emergency department (ED) presentations, accounting for approximately 3.4% of all ED visits over a 5-year period. 1 The differential diagnosis of flashes and floaters includes posterior vitreous detachment, retinal detachment, posterior uveitis, vitreous hemorrhage, oculodigital stimulation, rapid eye movements, neovascular age-related macular degeneration, migraine with aura, occipital lobe disorders, and postural hypotension. 2 While most patients will have a benign etiology, up to 10% to 26% of patients presenting with acute onset of flashes or floaters will be diagnosed with a

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Gottlieb

Holladay

Peksa

2019

Academic Emergency Medicine

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“…On B-scan, the normal spikes correspond to anterior lens capsule, posterior capsule, hypoechoic vitreous followed by the first high spike of the retina followed by the sclera. The retrobulbar fat is echogenic, and between this, the optic nerve can be seen as a tube-like hypoechoic channel extending from the sclera posteriorly towards the apex 1 2…”

Section: Descriptionmentioning

confidence: 99%

Simple way to optimise ultrasonographic visualisation of the retinal periphery and anterior segment structures

Pujari¹,

Swamy

Chawla

et al. 2017

BMJ Case Reports

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DESCRIPTIONThe ocular ultrasonography has evolved over years; the combined mode using A-scan and B-scan is very useful in the diagnosis of posterior segment pathology. Brightness mode helps in better evaluation of the mass lesion regarding their size, shape, extent and relationship with the remaining posterior segment structures. The frequency used for ophthalmic diagnosis is 8-10 MHz. The eyeball mainly encompasses the three coats: the sclera, choroid and retina. On B-scan, the normal spikes correspond to anterior lens capsule, posterior capsule, hypoechoic vitreous followed by the first high spike of the retina followed by the sclera. The retrobulbar fat is echogenic, and between this, the optic nerve can be seen as a tube-like hypoechoic channel extending from the sclera posteriorly towards the apex.

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Ocular Point-of-Care Ultrasonography to Diagnose Posterior Chamber Abnormalities

et al. 2020

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IMPORTANCE Diagnosing posterior chamber ocular abnormalities typically requires specialist assessment. Point-of-care ultrasonography (POCUS) performed by nonspecialists, if accurate, could negate the need for urgent ophthalmologist evaluation. OBJECTIVE This meta-analysis sought to define the diagnostic test characteristics of emergency practitioner-performed ocular POCUS to diagnose multiple posterior chamber abnormalities in adults. DATA SOURCES PubMed (OVID), MEDLINE, EMBASE, Cochrane, CINAHL, and SCOPUS were searched from inception through June 2019 without restrictions. Conference abstracts and trial registries were also searched. Bibliographies of included studies and relevant reviews were manually searched, and experts in the field were queried. STUDY SELECTION Included studies compared ocular POCUS performed by emergency practitioners with a reference standard of ophthalmologist evaluation. Pediatric studies were excluded. All 116 studies identified during abstract screening as potentially relevant underwent fulltext review by multiple authors, and 9 studies were included. DATA EXTRACTION AND SYNTHESIS In accordance with PRISMA guidelines, multiple authors extracted data from included studies. Results were meta-analyzed for each diagnosis using a bivariate random-effects model. Data analysis was performed in July 2019. MAIN OUTCOMES AND MEASURES The outcomes of interest were diagnostic test characteristics of ocular POCUS for the following diagnoses: retinal detachment, vitreous hemorrhage, vitreous detachment, intraocular foreign body, globe rupture, and lens dislocation. RESULTS Nine studies (1189 eyes) were included. All studies evaluated retinal detachment, but up to 5 studies assessed each of the other diagnoses of interest. For retinal detachment, sensitivity was 0.94 (95% CI, 0.88-0.97) and specificity was 0.94 (95% CI, 0.85-0.98). Sensitivity and specificity were 0.90 (95% CI, 0.65-0.98) and 0.92 (95% CI, 0.75-0.98), respectively, for vitreous hemorrhage and were 0.67 (95% CI, 0.51-0.81) and 0.89 (95% CI, 0.53-0.98), respectively, for vitreous detachment. Sensitivity and specificity were high for lens dislocation (0.97 [95% CI, 0.83-0.99] and 0.99 [95% CI, 0.97-1.00]), intraocular foreign body (1.00 [95% CI, 0.81-1.00] and 0.99 [95% CI, 0.99-1.00]), and globe rupture (1.00 [95% CI, 0.63-1.00] and 0.99 [95% CI, 0.99-1.00]). Results were generally unchanged in sensitivity analyses of studies with low risk of bias.

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Test characteristics of point-of-care ultrasonography for the diagnosis of acute posterior ocular pathology

Cited by 14 publications

References 14 publications

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Simple way to optimise ultrasonographic visualisation of the retinal periphery and anterior segment structures

Ocular Point-of-Care Ultrasonography to Diagnose Posterior Chamber Abnormalities

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