Eye-related Emergency Department Visits with Ophthalmology Consultation in Taiwan: Visual Acuity as an Indicator of Ocular Emergency

Abstract

to investigate the epidemiology of eye-related emergency department (eD) visits and to determine if visual acuity (VA) could be an indicator for determining the timing for managing ocular emergencies, we have conducted the retrospective study which included patients visited the eD for eye-related reasons and had received ophthalmology consultations at a referral center in Taiwan in 2015. Among 46,514 consultations, 5,493 were ophthalmology consultations (11.8%). After exclusion, 5,422 were eligible for analysis. Among them, 1,165 (21.5%) had not likely emergent diagnoses, 4,048 (74.7%) had likely emergent diagnoses, and 209 patients (3.9%) could not be determined. The logMAR VA was 0.31 ± 0.48, 0.66 ± 0.78, and 1.00 ± 0.94 in groups with not likely emergent, likely emergent, and undetermined diagnoses, respectively. Among all eye-related ED visits, 10.3% of patients received ophthalmologic intervention or were admitted to the ophthalmology ward. A LogMAR VA score of 0.45 (decimal equivalent of 0.4) had the highest discrimination power for identifying whether a patient needed ophthalmology intervention or admission to ophthalmology ward (area under the curve: 0.802, sensitivity: 0.800, specificity: 0.672). In our study, we found VA could be an indicator for determining the priority and time of ocular emergencies requiring ophthalmic intervention in patients visiting the ED for eye-related reasons. People often visit the emergency department (ED) first for some ocular diseases. The most commonly reported eye condition in the ED is conjunctivitis followed by corneal injury, eye pain, and hordeolum 1. Although the ED can offer rapid management of ocular problems, an excessive number of nonemergent eye-related visits may overcrowd the ED, and limit the resources available for real emergent ophthalmic and other medical issues 2. A US study reported that approximately half of all ocular ED visits were not related to emergent conditions 3. Informing patients on how to appropriately seek eye care was suggested 4. The cost of ED visits in Taiwan is covered by Taiwan's National Health Insurance, making Taiwan health care renowned for its low cost and overloaded services 5. The average treatment-associated expenditure and drug-associated expenditure for a single ED visit are NT$1,155

Deep Learning–Based Detection of Early Renal Function Impairment Using Retinal Fundus Images: Model Development and Validation

“…This difference in performance is attributable to differences in patient characteristics or model architecture. Our hospital is a referral medical center with comprehensive ophthalmology equipment for the management of advanced eye diseases [ 34 ]. Compared with population-based screening databases, our database featured more patients with pathologies on the retina or other parts of the eye, which may have increased the likelihood of model misdiagnosis [ 35 ].…”

Impact of Covid-19 pandemic on Ophthalmic Emergency Department in an Italian tertiary eye centre

“…In 2012, a systematic review reported that nearly 40% of all ED visits were for non-urgent conditions, 13 and more recently Channa et al 6 found a similar result in OED, with more than 40% of ophthalmic consultations being non-urgent. Nevertheless, OED urgency rates published by other groups are quite different from each other (21.5%, 14 35.8%, 15 50-70%, 16 over 30% 17 and 73% 18 ). In the COVID-free period, our urgency rate was 39.1%, with a 46.7% of non-urgent conditions.…”

“…Even in these studies, in fact, 'vision loss' was the symptom most associated with the degree of urgency of the diagnosed ocular disease. 23,24 Accordingly, in a recent work of Kang et al, 14 reported that visual acuity could be an effective indicator for determining priority and timing for ophthalmic consultations in patients visiting ED for eye-related reasons.…”

Ophthalmic Emergency-Room Visits During The COVID-19 Pandemic – A Comparative Study

“…Also, topical antibiotics, topical and systemic steroids and hypotensive drops were all prescribed more in 2020 as compared to 2019. A study from Taiwan [8] found that VA could be an indicator for determining the priority and time of ocular emergencies requiring ophthalmic intervention in patients visiting the ED for eye-related reasons. A LogMAR VA score of 0.45 (decimal equivalent of 0.4) had the highest discrimination power for identifying whether a patient needed ophthalmology intervention or admission to an ophthalmology ward.…”