Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States

Abstract

Background/objectives Patients with ophthalmic emergencies often present to emergency rooms. Emergency medicine (EM) physicians should feel comfortable encountering these conditions. We assessed EM physicians’ comfort working up, diagnosing, and managing ophthalmic emergencies. Subjects/methods 329 EM physicians participated in this cross-sectional multicentre survey. Questions inquired about the amount, type, and self-perceived adequacy of ophthalmic training. Likert scales were used to assess confidence and comfort working up, diagnosing, and managing ophthalmic emergencies. Results Participants recall receiving a median of 5 and 10 h of ophthalmic training in medical school and residency, respectively. Few feel this prepared them for residency (16.5%) or practice (52.0%). Only 50.6% feel confident with their ophthalmic exam. Most (75.0%) feel confident in their ability to identify an ophthalmic emergency, but 58.8% feel well prepared to work them up. Responders feel more comfortable diagnosing acute retrobulbar hematoma (72.5%), retinal detachment (69.8%), and acute angle closure glaucoma (78.0%) than central retinal artery occlusion (28.9%) or giant cell arteritis (53.2%). Only 60.2% feel comfortable determining if canthotomy and cantholysis is necessary in the setting of acute retrobulbar hematoma, and 40.3% feel comfortable performing the procedure. There was a trend towards attending physicians and providers in urban and academic settings feeling more comfortable diagnosing and managing ophthalmic emergencies compared to trainees, non-urban, and non-academic physicians. Conclusions Many participants do not feel comfortable using ophthalmic equipment, performing an eye exam, making vision or potentially life-saving diagnoses, or performing vision-saving procedures, suggesting the need to increase ophthalmic training in EM curricula.

Central retinal artery occlusion as a neuro‐ophthalmological emergency: the need to raise public awareness

“…This may be attributable, in turn, to insufficient levels of awareness and knowledge regarding emergent ophthalmic conditions in the population 19 . It also bears mentioning that acute painless monocular blindness is not represented in prehospital screening tools for stroke, and many emergency physicians do not feel confident in diagnosing CRAO, 20 which underscores the need for targeted interventions as well as early expert ophthalmological assessment. The latter is particularly important for several reasons.…”

Current diagnosis and treatment practice of central retinal artery occlusion: results from a survey among German stroke units

“…As a consequence, CRAO patients frequently present with considerable latency from symptom onset after an initial prehospital ophthalmology consultation [ 17 , 18 ]. Moreover, diagnosis of CRAO is challenging for many emergency physicians [ 19 ], and fundoscopy, a skill requiring extensive training and constant maintenance to be correctly performed and interpreted, is infrequently employed by non-ophthalmologists, including neurologists [ 20 ]. Hence, early expert in-hospital ophthalmological examination is an essential component of a comprehensive assessment of patients with UVL.…”

The burden of flashes and floaters in traditional general emergency services and utilization of ophthalmology on-call consultation: a cross-sectional study

“…Despite the incidence of eye-related visits to GES, several studies have highlighted the lack of comfort general emergency physicians have in managing eye-related issues. [18][19][20] Ophthalmology, along with orthopedics, represents one of the most frequently consulted services by GESs [16,21].…”