The use of ocular ultrasound for the diagnosis of retinal detachment in a local accident and emergency department

Abstract

Objectives: This study aimed to assess the accuracy of ocular ultrasound performed by emergency physicians for diagnosis of retinal detachment. Methods: This was a prospective single-center observational study conducted between September 2013 and February 2015. All adult patients presenting to the emergency department with acute onset of visual changes were eligible to participate. Patients who met one of the following criteria were excluded: a diagnosis of retinal detachment had already been made by an ophthalmologist prior to attendance; pre-existing retinal detachment currently under treatment; hemodynamically unstable; suspected rupture eyeball; and unable to give consent. Six emergency physicians performed emergency ocular ultrasound using a linear 10-MHz ultrasound probe. An abnormal lifting of the retina or the presence of a retinal flap was considered diagnostic of retinal detachment. The final diagnosis of the ophthalmologist who was blinded to the study was used as the gold standard.Results: Among the 139 patients evaluated, 16 (12%) had retinal detachments and 14 of them were correctly identified (true positives). Of the 123 patients (88%) without retinal detachment, 107 patients were correctly identified (true negatives). The sensitivity and specificity of emergency ocular ultrasound for retinal detachment were 88% (95% confidence interval = 60 to 98) and 87% (95% confidence interval = 79 to 92), respectively. Conclusion: Emergency ocular ultrasound is a useful adjunct for the diagnosis of retinal detachment.

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

“…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 .…”

“…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 .…”

“…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 .…”

“…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 …”

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

“…Lahham and colleagues 15 (225 patients) and Ojaghihaghighi et al 16 (232 patients) studied ocular POCUS to diagnose multiple posterior chamber abnormalities. Because of the expanding evidence regarding EP-performed POCUS for the evaluation of retinal detachment, 6,7,[11][12][13][15][16][17][18] and because, to our knowledge, no previous systematic review has evaluated the diagnostic utility of POCUS in diagnosing other posterior chamber abnormalities, the present body, and ruptured or open globe). Exclusion criteria were studies of patients younger than 18 years, POCUS operators who were not EPs, and case reports or case series of fewer than 10 patients.…”