Evaluating the variability of neuro-ophthalmic emergency management by practicing ophthalmologists in Canada

Abstract Body:

Purpose: The purpose of this prospective survey study was to identify variability in the management of neuro-ophthalmic emergencies by practicing ophthalmologists in Canada.

Study Design: This was a prospective survey study.

Methods: This study received ethics approval from the Ottawa Health Science Network Research Ethics Board. A web-based survey consisting of 6 neuro-ophthalmic patient case descriptions followed by multiple choice questions was developed by a practicing neuro-ophthalmologist (DA). The survey did not indicate that the patient scenarios depicted neuro-ophthalmic emergencies. The questions of the survey either asked participants to select the next best step in the management of the patient or asked participants to diagnose the patient. One point was awarded for each correct answer on the survey, with a maximum possible score of 6. The survey was distributed in English by the office of the COS Executive Director on behalf of the study team to the physician members of the COS. Two months following the dissemination of the survey, the responses were analyzed using Microsoft Excel®. Responses from neuro-ophthalmologists pertaining to case management were excluded from the analysis to evaluate ophthalmologists without neuro-ophthalmic subspecialty fellowship training.

Results: One hundred sixty-one ophthalmologists from across Canada completed the survey. Comprehensive ophthalmologists, retina specialists and pediatric ophthalmologists comprised 56%, 13% and 10% of the study sample respectively, and the remaining 21% of respondents were other subspecialists. 70% of respondents had a private-office based practice while 30% were primarily hospital-based. The vast majority of respondents (78%) indicated that 0-10% of their patients have neuro-ophthalmic disease. Case management responses by 7 neuro-ophthalmologists were excluded. The mean±SD score achieved on the survey was 5.0±0.92 points with a range of 2-6 points out of 6. 31.6% of respondents scored 6/6 points. 77% of respondents correctly identified urgent CT Head as their management of choice to rule out a case of papilledema. 84% of respondents correctly identified urgent CT to manage a case of pituitary apoplexy. The vast majority of participants (91%) correctly selected ESR/CRP/PLT to rule out GCA. Similarly, most participants (96%) selected urgent CTA to rule out a PCOM aneurysm in a case of third nerve palsy and 95% correctly diagnosed a patient with Mucormycosis. The area of greatest variability was in a case of carotid artery dissection causing Horner’s syndrome where 53% correctly selected CTA neck, however CT Chest and MRI Head was selected by 38% and 9% of respondents respectively.

Conclusions: Areas of variable neuro-ophthalmic emergency management by ophthalmologists have been identified. These results suggest that future continuing professional development modules pertaining to neuro-ophthalmology should focus on the emergent management of Horner’s syndrome.