Nonmydriatic Fundoscopic Imaging Using the Pan Optic iExaminer System in the Pediatric Emergency Department

Objectives: The primary objective of this study was to determine the percentage of clinically adequate (CA) fundoscopic images that could be obtained using the Pan Optic iExaminer system to perform nonmydriatic fundoscopic imaging in the pediatric emergency department (ED). Secondary objectives were to identify target age groups in which this technology is best utilized and evaluate the overall ease of use in this setting. Methods: Children 18 years of age or less who presented to the pediatric ED with a non-eye-related chief complaint were enrolled and stratified by age group (0-2, 2-6, and 6-18 years). Each enrolled patient underwent a bilateral eye examination using the Pan Optic iExaminer system. Images were submitted for review to a pediatric ophthalmologist and were graded based on clarity and field of view. Ease of use was defined as 80% of patients having at least one image of quality to be considered "clinically adequate" for obtaining a full view of the optic nerve, examination time for both eyes 15 minutes or less, and three attempts or less for each eye. Results: Overall, 91.06% (95% confidence interval [CI] = 86.01% to 96.1%) of children ages 2-18 years had at least one CA image obtained. A total of 16% (95% CI = 7% to 26%) of children 0-2 years, 85% (95% CI = 76% to 94.15%) of children 2-6 years, and 9% (95% CI = 92% to 100%) of 6-18 years had at least one CA image. The median total examination time was 3 minutes 24 seconds (interquartile range = 2 minutes 27 seconds to 4 minutes 49 seconds). Conclusion: Fundoscopic images were consistently obtained using the Pan Optic iExaminer system in the pediatric ED particularly in children 2-18 years of age. CA images were obtained in children less than 2 years old, but less consistently.