Smartphone ophthalmoscopy for assessment of hypertensive retinopathy in suspected hypertensive emergency: a pilot study.

BACKGROUND

Fundoscopy is of pivotal importance in patients with suspected hypertensive emergency in order to detect hypertensive retinopathy and determine the need for prompt intravenous antihypertensive treatment. However, direct fundoscopy by an ophthalmologist is time-consuming and delays treatment. In this pilot study in the emergency department (ED), we evaluated whether smartphone ophthalmoscopy is a feasible and faster alternative.

METHODS

We evaluated duration of ED-treatment in patients who underwent smartphone ophthalmoscopy for suspected hypertensive emergency. Smartphone ophthalmoscopy included 30-second retinal video recordings captured by the attending physicians, which were remotely evaluated by an ophthalmologist. Patients in the smartphone-group were matched in a 1:2-ratio to a historical cohort who underwent direct fundoscopy by an ophthalmologist. We evaluated total ED-length-of-stay (total ED-LOS; defined as the interval between ED-admission and ED-discharge) and 'treatment time' (defined as total ED-LOS minus time in waiting room).

RESULTS

In the present analysis, we included 54 patients in the smartphone-group and matched them with 108 historical controls. On average, total ED-LOS was 29 minutes shorter in the smartphone-group as compared to controls (217 ± 73 minutes vs. 246 ± 73 minutes; P = 0.016). Treatment time was 40 minutes shorter in the smartphone-group (193 ± 68 minutes vs. 233 ± 71 minutes; P = 0.002). Stratified analyses suggested that the reduction in treatment time was most pronounced outside office hours. Smartphone ophthalmoscopy was feasible in 87% of the patients, the other 13% (n = 10) required additional direct fundoscopy by an ophthalmologist.

CONCLUSIONS

Smartphone ophthalmoscopy in suspected hypertensive emergency was feasible and faster as compared to direct fundoscopy by an ophthalmologist, which may allow earlier treatment and reduce ED-crowding.