Point-of-Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta-Analysis

BACKGROUND Ocular complaints are common presentations to the Emergency Department (ED). Among these, retinal detachment can cause significant vision loss if not rapidly diagnosed and referred for appropriate treatment. Point-of-care ultrasound has been suggested to identify the diagnosis rapidly when the ocular examination is limited or the ophthalmology service is not readily available. However, prior studies were limited by small sample sizes, resulting in wide ranges of potential accuracy. The primary outcome for this review was to determine the test characteristics of point-of-care ocular ultrasound for the diagnosis of retinal detachment.
METHODS PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all prospective and randomized controlled trials assessing the accuracy of point-of-care ultrasound for identifying retinal detachment. Data were dual extracted into a predefined worksheet and quality analysis was performed using the QUADAS-2 tool. Data were summarized and a meta-analysis was performed with planned subgroup analyses by location and provider specialty. This review was registered with PROSPERO [blinded for peer review]. There was no funding for this review.
RESULTS Eleven studies (n=844 patients) were identified. Overall, ultrasound was 94.2% (95% CI 78.4% to 98.6%) sensitive and 96.3% (95% CI 89.2% to 98.8%) specific for the diagnosis of retinal detachment with a LR+ of 25.2 (95% CI 8.1 to 78.0) and a LR- of 0.06 (95% CI 0.01 to 0.25). Subgroup analysis found that ultrasound was more accurate among ED patients, but was not significantly different when performed by ED or non-ED providers.
CONCLUSIONS Point-of-care ocular ultrasound is sensitive and specific for the diagnosis of retinal detachment. Future studies should determine the ideal training protocol and the influence of color Doppler and contrast-enhanced ultrasound on diagnostic accuracy. This article is protected by copyright. All rights reserved.

as reported in: Acad Emerg Med. 2019 Jan 13 [Epub ahead of print]