Bridging the Gap between Ophthalmology and Emergency Medicine in Community-Based Emergency Departments (EDs): A Neuro-Ophthalmology Guide for ED Practitioners

Abstract

Coordination of care for patients with neuro-ophthalmic disorders can be very challenging in the community emergency department (ED) setting. Unlike university- or tertiary hospital-based EDs, the general ophthalmologist is often not as familiar with neuro-ophthalmology and the examination of neuro-ophthalmology patients in the acute ED setting. Embracing image capturing of the fundus, using a non-mydriatic camera, may be a game-changer for communication between ED physicians, ophthalmologists, and tele-neurologists. Patient care decisions can now be made with photographic documentation that is then conveyed through HIPAA-compliant messaging with accurate and useful information with both ease and convenience. Likewise, external photos of the anterior segment and motility are also helpful. Finally, establishing clinical and imaging guidelines for common neuro-ophthalmic disorders can help facilitate complete and appropriate evaluation and treatment.

The patient journey with NMOSD: From initial diagnosis to chronic condition

“…Patients describe fear, frustration, and disappointment. Patients describe how they were often confronted with sudden, distressing, and painful attacks of NMOSD with relatively little support or understanding from the medical community, especially emergency departments, primary care physicians, and neurologists, due to lack of knowledge of NMOSD ( 19 ). Increased understanding of NMOSD by physicians can help preserve vision and avoid permanent disability as well as help patients transition more efficiently to the right specialists ( 19 ).…”

“…Patients describe how they were often confronted with sudden, distressing, and painful attacks of NMOSD with relatively little support or understanding from the medical community, especially emergency departments, primary care physicians, and neurologists, due to lack of knowledge of NMOSD ( 19 ). Increased understanding of NMOSD by physicians can help preserve vision and avoid permanent disability as well as help patients transition more efficiently to the right specialists ( 19 ). Finding the right specialist and identifying appropriate screening tests can lead to an earlier correct diagnosis and faster progress toward better treatment and outcomes ( 10 , 19 ).…”

“…Increased understanding of NMOSD by physicians can help preserve vision and avoid permanent disability as well as help patients transition more efficiently to the right specialists ( 19 ). Finding the right specialist and identifying appropriate screening tests can lead to an earlier correct diagnosis and faster progress toward better treatment and outcomes ( 10 , 19 ).…”

“…NMOSD is frequently misdiagnosed, especially in patients with clinical signs who are seronegative for established biomarkers such as AQP4-IgG and myelin oligodendrocyte glycoprotein autoantibodies (MOG-IgG) ( 3 , 10 , 17 ). Primary care providers and emergency departments, who are often the first points of health care contact, generally have limited or no experience diagnosing and/or treating patients with NMOSD ( 17 – 19 ).…”

Optic neuropathy diagnosis in the emergency room - retrospective observational study of the last 18 years

“…4 Although the clinical diagnosis of ON can be usually reached with an adequate initial observation, determining the specific cause of the ON can represent a greater difficulty, particularly in the emergency care setting, making the diagnosis established ab initio potentially redefined after follow-up and/or further investigations. 9 Currently, ON remains mostly a clinical diagnosis; nevertheless, advances in optic nerve imaging, as well as antibody testing, have gained growing importance in the diagnosis and follow-up of patients with ON, 1,2,10,11 despite their possible risk of misdiagnosis. 11,12 There is limited data and reports regarding the presentation and examination of optic neuropathies in the ER setting.…”