Eye exams using lighted, hand-held instruments now done infrequently, study finds

November 20, 2015

MAYWOOD, Ill. - For more than 150 years, physicians have examined patients' eyes with a lighted, hand-held instrument called an ophthalmoscope.

In addition to eye problems, the exam can detect indications of many other problems, including neurological conditions that can cause headaches or altered mental status. The exam is called direct funduscopy.

However, a Loyola University Medical Center study has found that direct funduscopy exams are being performed infrequently. Researchers who examined records of 163 adult patients found that direct funduscopy was used during the initial evaluation on only 26 percent of patients with primary visual symptoms, 25 percent of patients with headaches and 5 percent of patients with altered mental status. The study is published in the journal Frontiers in Neurology.

"It is disturbing that the funduscopic examination has been shown to be one of the clinical skills physicians are least confident performing," senior author Jose Biller, MD, and colleagues wrote. "In not performing direct funduscopy, valuable clinical information may be missed." Dr. Biller is chair of the Department of Neurology of Loyola University Chicago Stritch School of Medicine.

In a funduscopic exam, the physician sits close to the patient and shines the ophthalmoscope into the pupil, a hole in the eye through which the fundus can be seen. (The fundus is the back portion of the interior of the eyeball.) The physician can see magnified images of the retina and other structures, including a direct view of blood vessels and the central nervous system.

A funduscopic exam can detect such problems as bleeding from blood vessels in the retina and increased pressure in the brain, which can cause headaches, double vision and other problems.

The Association of University Professors of Ophthalmology says all physicians should be able to perform direct funduscopies.

Loyola researchers reviewed records of 163 patients treated at an academic medical center for headaches, altered mental status and visual changes. Internists performed direct funduscopies on 11 percent of patients; emergency medicine physicians performed the exam on 20 percent of patients; and neurologists performed it on 43 percent of patients. Researchers suspect their findings probably are widespread.

The retrospective chart study did not determine why direct funduscopies are performed so infrequently. Researchers speculate the reasons are similar to those given in a previous study: not enough time; inadequate skills; lack of available equipment; and a belief that direct funduscopy isn't useful.

Researchers said their findings illustrate the importance of including direct funduscopy among the basic clinical competencies taught during medical school and neurology residency training.
-end-
In addition to Dr. Biller, other co-authors of the study are Esteban Golombievski, MD, (first author); Michael Doerrler, DO; Sean Ruland, DO; and Matthew McCoyd, MD.

The study is titled 'Frequency of Direct Funduscopy Upon Initial Encounters for Patients with Headaches, Altered Mental Status and Visual Changes: A Pilot Study.'

Loyola University Health System

Related Blood Vessels Articles from Brightsurf:

Biofriendly protocells pump up blood vessels
In a new study published today in Nature Chemistry, Professor Stephen Mann and Dr Mei Li from Bristol's School of Chemistry, together with Associate Professor Jianbo Liu and colleagues at Hunan University and Central South University in China, prepared synthetic protocells coated in red blood cell fragments for use as nitric oxide generating bio-bots within blood vessels.

Specific and rapid expansion of blood vessels
Upon a heart infarct or stroke, rapid restoration of blood flow, and oxygen delivery to the hypo perfused regions is of eminent importance to prevent further damage to heart or brain.

Flexible and biodegradable electronic blood vessels
Researchers in China and Switzerland have developed electronic blood vessels that can be actively tuned to address subtle changes in the body after implantation.

Lumpy proteins stiffen blood vessels of the brain
Deposits of a protein called ''Medin'', which manifest in virtually all older adults, reduce the elasticity of blood vessels during aging and hence may be a risk factor for vascular dementia.

Cancer cells take over blood vessels to spread
In laboratory studies, Johns Hopkins Kimmel Cancer Center and Johns Hopkins University researchers observed a key step in how cancer cells may spread from a primary tumor to a distant site within the body, a process known as metastasis.

Novel function of platelets in tumor blood vessels found
Scientists at Uppsala University have discovered a hitherto unknown function of blood platelets in cancer.

Blood vessels can make you fat, and yet fit
IBS scientists have reported Angiopoietin-2 (Angpt2) as a key driver that inhibits the accumulation of potbellies by enabling the proper transport of fatty acid into general circulation in blood vessels, thus preventing insulin resistance.

Brothers in arms: The brain and its blood vessels
The brain and its surrounding blood vessels exist in a close relationship.

Feeling the pressure: How blood vessels sense their environment
Researchers from the University of Tsukuba discovered that Thbs1 is a key extracellular mediator of mechanotransduction upon mechanical stress.

Human textiles to repair blood vessels
As the leading cause of mortality worldwide, cardiovascular diseases claim over 17 million lives each year, according to World Health Organization estimates.

Read More: Blood Vessels News and Blood Vessels Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.