Test characteristics of point-of-care ultrasonography for the diagnosis of acute posterior ocular pathology

Michael Y Woo, Nathan Hecht, Bernard Hurley, David Stitt, Venkatesh Thiruganasambandamoorthy
Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie 2016, 51 (5): 336-341

OBJECTIVES: The objective of this study was to determine the test characteristics of point-of-care ultrasonography (POCUS) for the diagnosis of retinal tear (RT), retinal detachment (RD), posterior vitreous detachment (PVD), and vitreous hemorrhage (VH).

DESIGN: A prospective observation study on a convenience sample of patients presenting to a tertiary care emergency general ophthalmology clinic was performed.

PARTICIPANTS: Adult patients with acute flashes/floaters or new visual field defects were included (n = 62).

METHODS: POCUS was performed by a study sonographer and compared with a retina specialist examination without sonography imaging. Sonographers were masked to clinical information. Follow-up was performed by a 6-week health records review. The primary outcome was the diagnosis of RD/RT, PVD, and VH. Analyses included descriptive statistics and test characteristics.

RESULTS: A total of 62 patients with a mean age of 60.8 years were enrolled; 62.9% were female. The mean time to scan required was 7.4 minutes. There was no change in diagnosis at 6 weeks. The sensitivities and specificities, respectively, are as follows: any pathology (n = 60) 88.3% (95% CI 86.8%-89.9%) and 50% (95% CI 2.7%-97.3%); RD (n = 6) 100% (95% CI 53.9%-100%) and 67.9% (95% CI 62.9%-67.9%); RD/RT (n = 23) 47.8% (95% CI 30.8%-62.2%) and 82.1% (95% CI 72.0%-90.6%); PVD (n = 47) 80.9% (95% CI 74.7%-88.0%) and 33.3% (95% CI 14.0%-55.7%); and VH (n = 14) 43.0% (95% CI 21.4%-58.0%) and 93.8% (95% CI 87.5%-98.2%).

CONCLUSIONS: Ocular POCUS detected all RDs but has limited use for the diagnosis of RTs. Patients with suspected acute ocular posterior pathology should be referred to ophthalmology independent of ocular POCUS.

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