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Abstract
<p class="first" id="P1">Examination of the ocular fundus is a critical aspect of
the neurological examination.
For example, in patients with headache the ocular fundus examination is needed to
uncover “red flags” suggestive of secondary etiologies. However, ocular fundus examination
is infrequently and poorly performed in clinical practice. Non-mydriatic ocular fundus
photography provides an alternative to direct ophthalmoscopy that has been studied
as part of the Fundus photography vs. Ophthalmoscopy Trial Outcomes in the Emergency
Department (FOTO-ED) study. Herein, we review the results of the FOTO-ED study with
a particular focus on the study's implications for the acute care of patients presenting
with headache and focal neurologic deficits. In headache patients, we not only observed
optic disc edema and optic disc pallor as would be expected, but also a large number
of abnormalities associated with hypertension. Based upon subjects with focal neurological
deficits, the FOTO-ED study suggests that the ocular fundus examination may assist
with the triage of patients presenting with suspected transient ischemic attack. Continued
advances in the ease and portability of non-mydriatic fundus photography will hopefully
help to restore ocular fundus examination as a routinely performed component of all
neurological examinations.
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