Karine D Bojikian, Thellea K Leveque, Anna McEvoy, Blake Hopkin, Nadia Popovici, Hyrum Hopkin, Grant Howell, Mary E Kim, Jennifer T Yu, Andrew Chen, Leona Ding, Parisa Taravati, Kristina Tarczy-Hornoch, Shu Feng
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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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"19 ","pages":"683-690"},"PeriodicalIF":0.0000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871949/pdf/","citationCount":"0","resultStr":"{\"title\":\"Assessment of Emergency Department Intraocular Pressure and Visual Acuity Assessment as a Screening Exam.\",\"authors\":\"Karine D Bojikian, Thellea K Leveque, Anna McEvoy, Blake Hopkin, Nadia Popovici, Hyrum Hopkin, Grant Howell, Mary E Kim, Jennifer T Yu, Andrew Chen, Leona Ding, Parisa Taravati, Kristina Tarczy-Hornoch, Shu Feng\",\"doi\":\"10.2147/OPTH.S511327\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":93945,\"journal\":{\"name\":\"Clinical ophthalmology (Auckland, N.Z.)\",\"volume\":\"19 \",\"pages\":\"683-690\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-02-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871949/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical ophthalmology (Auckland, N.Z.)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2147/OPTH.S511327\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical ophthalmology (Auckland, N.Z.)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/OPTH.S511327","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的:评价急诊科(ED)评估眼压(IOP)和视力(VA)测量作为筛查眼压和VA异常的工具在眼科检查中的应用价值。患者和方法:这项回顾性横断面研究回顾了2022年2月1日至2023年1月31日期间在Harborview和华盛顿大学医学中心(Seattle, WA)进行眼科会诊的眼科相关急诊科患者。本文回顾了急诊科和眼科部门获得的右眼和左眼IOP和VA电子病历。结果:在1463次就诊中,ED分别记录了627例(42.8%)和821例(56.1%)患者至少1只眼的IOP和VA异常。ED筛查患者工作曲线的曲线下面积(AUC)检测异常IOP为0.846,检测异常VA为0.863,>25 mmHg检测ED IOP的敏感性为0.78 (95% CI 0.69 ~ 0.87),特异性为0.84 (95% CI 0.80 ~ 0.87)。VA值logMAR >.3(小于20/40)对ED检测的敏感性为0.88 (95% CI 0.85-0.91),特异性为0.59 (95% CI 0.54-0.65)。结论:ED获得的IOP和VA测量有助于眼科检查中IOP和VA异常的筛查。然而,在眼科会诊之前,ED很少获得IOP和VA。
Assessment of Emergency Department Intraocular Pressure and Visual Acuity Assessment as a Screening Exam.
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.