Using non-mydriatic fundus photography to detect fundus pathology in Australian metropolitan emergency departments

a prospective prevalence and diagnostic accuracy study

Hamish P. Dunn*, Kai Zong Teo, James W. P. Smyth, Lakni S. Weerasinghe, Julia Costello, Preethi Pampapathi, Lisa Keay, Tim Green, Matthew Vukasovic, Beau B. Bruce, Nancy J. Newman, Valérie Biousse, Andrew J. White, Peter McCluskey, Clare L. Fraser

*Corresponding author for this work

Research output: Contribution to journalArticle


Objective: To determine the prevalence of fundus pathology in metropolitan Australian EDs utilising a non-mydriatic fundus photography screening programme. Secondary objectives include diagnostic accuracy among emergency physicians compared to telehealth ophthalmologist review. Methods: Prospective cross-sectional study investigating non-mydriatic fundus photography as a new diagnostic test in two tertiary Australian EDs. Consecutive adult patients were enrolled if they presented with headache, focal neurological deficit, visual disturbance or diastolic BP >120 mmHg. Diagnostic agreement was determined using kappa statistics and sensitivity and specificity using a reference standard consensus ophthalmology review. Results: A total of 345 consecutive patients were enrolled among whom 56 (16%, 95% confidence interval [CI] 13–21) had urgent fundus pathology. Agreement between emergency physician and ophthalmic assessment of fundus photographs was 74% (kappa = 0.196, P = 0.001). Emergency physicians had 40% sensitivity (95% CI 27–54) and 82% specificity (95% CI 76–86) for detecting urgent pathology on photographs. Conclusions: Fundus photography detects a clinically significant proportion of fundus pathology and urgent diagnoses. Telehealth specialist image review is important to detect some important, time-critical illnesses that can be missed in routine care. This offers an accurate alternative to direct ophthalmoscopy that warrants further research in Australian EDs.

Original languageEnglish
Number of pages8
JournalEMA - Emergency Medicine Australasia
Publication statusE-pub ahead of print - 17 Sep 2020
Externally publishedYes


  • fundus oculi
  • headache
  • neurology
  • physical examination
  • telemedicine

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