Use of ultrasound in diagnosing ocular pathologies in Emergency Department
Date First Published:
December 31, 2010
Last Updated:
January 14, 2011
Report by:
M Azam Majeed, St6 ED (Alexandra hospital, Redditch)
Search checked by:
M Azam Majeed, Alexandra hospital, Redditch
Three-Part Question:
In [patients with suspected Retinal Detachment, Posterior Vitreous Detachment or Vitreous Haemorrhage presenting to the Emergency department] is [ocular ultrasound] along with standard ocular examination [highly sensitive and specific] for diagnosis?
Clinical Scenario:
An adult male presents to the ED with flashes and floaters, and a curtain falling across the eye. Following standard ocular examination, there is a suspicion of RD, PVD or VH.
Could ocular ultrasound performed by an ED physician help in confirming the diagnosis and accelerate his further management?
Could ocular ultrasound performed by an ED physician help in confirming the diagnosis and accelerate his further management?
Search Strategy:
The following databases/ search engines were queried:
1.tMEDLINE 1951 to date
2.tCOCHRANE Library
3.tGoogle scholar
Terms used:
1.tMEDLINE; exp *ULTRASONOGRAPHY/; 101402 results.
2.tMEDLINE; exp *RETINAL DETACHMENT/di [di=Diagnosis]; 643 results.
3.tMEDLINE; exp *VITREOUS DETACHMENT/di [di=Diagnosis]; 41 results.
4.tMEDLINE; exp *VITREOUS HEMORRHAGE/di [di=Diagnosis]; 55 results.
5.tMEDLINE; 2 OR 3 OR 4; 720 results.
6.tMEDLINE; 1 AND 5; 44 results.
We used the same terminology for other search engines.
1.tMEDLINE 1951 to date
2.tCOCHRANE Library
3.tGoogle scholar
Terms used:
1.tMEDLINE; exp *ULTRASONOGRAPHY/; 101402 results.
2.tMEDLINE; exp *RETINAL DETACHMENT/di [di=Diagnosis]; 643 results.
3.tMEDLINE; exp *VITREOUS DETACHMENT/di [di=Diagnosis]; 41 results.
4.tMEDLINE; exp *VITREOUS HEMORRHAGE/di [di=Diagnosis]; 55 results.
5.tMEDLINE; 2 OR 3 OR 4; 720 results.
6.tMEDLINE; 1 AND 5; 44 results.
We used the same terminology for other search engines.
Search Details:
A total of 44 papers were retrieved, of which 7 were found relevant to all parts of question. Additionally 5 studies by the radiology and ophthalmology departments reporting on the sensitivity of US in diagnosing ocular pathologies have been included.
Outcome:
There isn’t any level 1or 2 evidence available in the literature relevant to my three part question but the available evidence does show that ocular US is highly sensitive to diagnose RD, PVD and VH in the EDs.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| A study of bedside ocular ultrasonography in the Emergency department. Blaivas M, Theodoro D, Sierzenski PR. 2002, USA | 61 pts with ocular complaints ED |
Single blinded, prospective, observational study | Sensitivity 100% | Specificity 97.2% | Non randomized Small sample Convenience sample Training issues No consent information |
| Use of Ocular Ultrasound for the Evaluation of Retinal Detachment. Shinar Z, Chan L, Orlinsky M. 2009, USA | 92 examinations, Adult ED |
Prospective, observational study | Sensitivity 97% | Specificity 92% | Small sample Training issues No consent information Convenience sample |
| Retinal Detachment Diagnosed by Bedside Ultrasound in the Emergency Department. Kahn A; Khan AL; Corinaldi CA et al. 2005, USA | 1 pt - 60yrs ,Adult, ED |
Case report | Case report, No statistical relevance Nothing about the operator training |
||
| Diagnosis of Retinal Detachment in the ED with Ultrasonography Elia J , Borger R. 2009, USA | 1 pt - 79yrs old, Adult, ED |
Case report | No statistical relevance Case report Nothing about the operator training Confirmatory method not stated, No further follow up documented |
||
| Pediatric retinal detachment due to Coats' disease diagnosed with bedside emergency department ultrasound. Buzzard AK, Linklater DR, 2009, USA | Paediatric , ED |
Case report | No statistical relevance Case report Nothing about the operator training |
||
| Ultrasonographic diagnosis of retinal detachment in the emergency department. Lewin MR, Williams SR, Ahuja Y. 2005, USA | 35yrs, Adult, ED |
Case report | No statistical relevance Case report Nothing about the operator training How it was confirmed afterwards No further follow up |
||
| Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage. R Rabinowitz, R Yagev, A Shoham et al. 2004, Israel | 96 pts, 106 eyes, Adults, With dense Vitreous haemorrhage |
Retrospective, Case series |
100% sensitivity | 100% specificity | Small number, Selection bias, No consent documentation, No Ethical approval and No operator training documentation |
| Early Ultrasonographic diagnosis of retinal detachment: multidisciplinary approach and benefit. Cabric E, Salihefendic N, Zildzic M et al. 2010, Bosnia and Herzegovina. | 667 pts With suspected ocular pathologies & pre-op for cataract surgery |
Case series | Didn’t mention whether retrospective or prospective, no clear objectives, No consent mentioned, No description of statistical method, statistical significance. No documentation of gold standard. | ||
| B-scan ultrasonography to screen for retinal tears in acute asymptomatic Age related posterior vitreous detachment Lorenzo-Carrero J, Perez-Flores I, Cid-Galano M, et al. 2009 USA | 239 pts, Adults, Mean age 65yrs |
Prospective, cross sectional, Single blinded |
96.4% sensitive | 98% specific | Selection bias Small sample |
| Ultrasonic patterns in Vitreo- Retinal disease Innes J, McCreath G, Forrester JV. 1982, UK | 134 pts Adults Pts referred to ophthalmologist for ocular US |
Case series | Small sample, Doesn’t say prospective or retrospective, No documentation about consenting the patients, No statistical method given | ||
| Comparison of Ultrasound and Intra-operative findings in patients with Vitreous haemorrhage. S. Kim and S. Lee. 2005, Korea | 81 pts with dense vitreous hemorhage | Retrospective study | 89% sensitive | 92% specific | Abstract, no statistical method, small number |
Bottom Line:
There isn’t any level 1or 2 evidence available in the literature relevant to my three part question but the available evidence does show that ocular US is highly sensitive to diagnose RD, PVD and VH in the EDs.
References:
- Blaivas M, Theodoro D, Sierzenski PR.. A study of bedside ocular ultrasonography in the Emergency department.
- Shinar Z, Chan L, Orlinsky M.. Use of Ocular Ultrasound for the Evaluation of Retinal Detachment.
- Kahn A; Khan AL; Corinaldi CA et al.. Retinal Detachment Diagnosed by Bedside Ultrasound in the Emergency Department.
- Elia J , Borger R.. Diagnosis of Retinal Detachment in the ED with Ultrasonography
- Buzzard AK, Linklater DR, . Pediatric retinal detachment due to Coats' disease diagnosed with bedside emergency department ultrasound.
- Lewin MR, Williams SR, Ahuja Y.. Ultrasonographic diagnosis of retinal detachment in the emergency department.
- R Rabinowitz, R Yagev, A Shoham et al.. Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage.
- Cabric E, Salihefendic N, Zildzic M et al.. Early Ultrasonographic diagnosis of retinal detachment: multidisciplinary approach and benefit.
- Lorenzo-Carrero J, Perez-Flores I, Cid-Galano M, et al. . B-scan ultrasonography to screen for retinal tears in acute asymptomatic Age related posterior vitreous detachment
- Innes J, McCreath G, Forrester JV.. Ultrasonic patterns in Vitreo- Retinal disease
- S. Kim and S. Lee.. Comparison of Ultrasound and Intra-operative findings in patients with Vitreous haemorrhage.