Study by leading Loyola neurologist examines the infrequency of traditional eye exams | Neurology & Neurosurgery, Ophthalmology | Loyola Medicine
Tuesday, November 24, 2015

Study by leading Loyola neurologist examines the infrequency of traditional eye exams

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.

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.”

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About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.