Assessment of Emergency Department Intraocular Pressure and Visual Acuity Assessment as a Screening Exam.

Abstract

Purpose: To evaluate the utility of Emergency Department (ED) assessment of intraocular pressure (IOP) and visual acuity (VA) measurements as a screening tool for abnormal IOP and VA on ophthalmology exams.

Patients and methods: This retrospective cross-sectional study reviewed eye-related ED visits between February 1, 2022, and January 31, 2023, at Harborview and University of Washington Medical Centers (Seattle, WA) with same-day ophthalmology consultation. Electronic medical records were reviewed for right eye and left eye IOP and VA obtained by ED and ophthalmology services. The ED exam as a screening tool for abnormal IOP (>25 mmHg) and visual acuity (<20/40) on ophthalmology exam in either eye was evaluated using receiver operating curves (ROC). A calculator user interface was created to report sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with a range of user inputs for both the thresholds applied to ED measurements and the targets for detection for Ophthalmology IOP and VA.

Results: Of 1463 visits, IOP and VA were recorded in at least 1 eye by the ED in 627 (42.8%) and 821 (56.1%) patients, respectively. The area under the curve (AUC) for the receiver operating curves for ED screening was 0.846 for detecting an abnormal IOP and 0.863 for detecting an abnormal VA. The sensitivity of a value >25 mmHg on ED IOP testing was 0.78 (95% CI 0.69-0.87), and the specificity was 0.84 (95% CI 0.80-0.87). The sensitivity of a VA value logMAR >0.3 (worse than 20/40) on ED testing was 0.88 (95% CI 0.85-0.91), and the specificity was 0.59 (95% CI 0.54-0.65).

Conclusion: ED acquired measurements of IOP and VA are useful to screen for abnormalities in IOP and VA on the ophthalmology exam. However, IOP and VA are infrequently obtained by the ED prior to ophthalmic consultation.