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

Abstract

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

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

“…This resulted in the exclusion of 5 studies of radiologist-performed POCUS included in the systematic review by Gottlieb and colleagues, 14 which included a wide range of POCUS operators assessing for retinal detachment. Nonetheless, our results were consistent with those reported by Gottlieb et al 14 In addition, we found good-to-excellent diagnostic accuracy in assessing for vitreous hemorrhage, lens dislocation, intraocular foreign body, and globe rupture, although the 95% CIs around some of our results are wide. Interestingly, POCUS appears to be less accurate in diagnosing vitreous detachment.…”

“…A recently published systematic review and meta-analysis 14 demonstrated sensitivity and specificity of 94% and 96%, respectively, for ocular POCUS to diagnose retinal detachment. The meta-analysis 14 included studies of POCUS performed by a range of practitioners, including radiologists and ophthalmologists, and included a total of 844 patients from 11 studies. Subsequently, 2 large, prospective studies 15,16 have added substantially to the existing data regarding EP-performed ocular POCUS.…”

Diagnostic Ultrasound Safety Review for Point‐of‐Care Ultrasound Practitioners

“…The versatility of US is extensive; see Table for a list of clinical conditions that potentially can be ascertained with US. For example, appropriately trained emergency physicians can effectively use US to accurately diagnose the conditions of patients who present to the emergency department, including those with conditions related to early pregnancy, possible pericardial effusion, abdominal aortic aneurysm, undifferentiated shortness of breath, and vision loss with retinal detachment and those patients who have been traumatically injured . The ability to perform and interpret these US examinations allows clinicians to diagnose potentially life‐threatening conditions in a timely manner.…”

The First Multicenter Evidence for Ocular Point-of-Care Ultrasonography for Retinal Detachment by Emergency Physicians

“…5 Accuracy for RD was much higher in the trainees and the EPs who enrolled 3 or more patients, possibly reflecting a higher level of training. In 2019, Gottlieb et al 6 published the largest systematic review and meta-analysis to date, to my knowledge, examining ocular POCUS for RD, including the study by Kim et al 5 and 10 other studies, with 844 total patients. In the 5 ED studies, ocular POCUS had a pooled sensitivity of 92% (95% CI, 67%-99%) and specificity of 91% (95% CI, 85%-95%).…”