POCUS for Retinal Detachment - Be Careful

Written by Clay Smith

Spoon Feed
In less experienced sonographers, ocular ultrasound for retinal detachment (RD) was specific but not sensitive.  It's useful to rule it in, but don't use it as the sole means to rule it out.

Why does this matter?
Ocular ultrasound is easy to do and may show a retinal detachment (RD) flapping in the breeze.  Seems like this would be something we couldn't miss, and prior studies have shown that we are pretty good at this. But how good is point-of-care ultrasound (POCUS) as a diagnostic test for RD in the hands of a group of emergency physicians with varying skill level at ultrasound?

In the eye of the probe-holder...
Patients with flashes or floaters were prospectively enrolled, N = 115.  POCUS was compared to the gold standard - retina specialist final diagnosis.  Of 30 emergency physicians with varying ultrasound skills and a one-hour didactic on eye ultrasound, they found the specificity was high (94%) but sensitivity lacking (75%). Of the four false negatives, one was thought to be posterior vitreous detachment and the other vitreous hemorrhage.  So if you see RD, it's really there.  But using it as a screening tool alone to rule out RD is not recommended for less experienced sonographers.

Another Spoonful
If you want to improve your chance of detecting RD, watch this quick video by Rob Ferre, our Vanderbilt ultrasound guru.

Source
Test Characteristics of Point of Care Ultrasound for the Diagnosis of Retinal Detachment in the Emergency Department.  Acad Emerg Med. 2018 May 18. doi: 10.1111/acem.13454. [Epub ahead of print]
Open in Read by QxMD

Reviewed by Thomas Davis

Another Spoonful
Ultrasound Gel Podcast has an excellent summary on PVD vs RD using POCUS.

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