Abstract Details

Title Examining referral patterns to neuro-ophthalmologists

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) S28 - Neuro-ophthalmology/Neuro-otology (3:52 PM-4:03 PM)

Poster/Presentation
Number 003

Background

Neuro-ophthalmologists specialize in complex, urgent, vision- and life-threatening problems, diagnostic dilemmas, and management of complex work-ups. Access is currently limited by a relatively small number of neuro-ophthalmologists, and patients may be affected by incorrect or delayed diagnosis of these conditions.

Objective To analyze referral patterns to neuro-ophthalmologists, characterize rates of misdiagnoses and delayed diagnoses in patients referred, and to identify characteristics of referrals likely to benefit most from neuro-ophthalmologic evaluation.

Design/Methods Retrospective chart review of 300 new patients seen over 45 randomly-chosen days between 06/2011-06/2015 in one tertiary care neuro-ophthalmology clinic. Date range was chosen to use comprehensive paper charting. Demographics, distance traveled, time between onset and consultation, time between appointment request and consultation, providers seen before referral, unnecessary tests before referral, referral diagnoses, final diagnoses, and impact of the neuro-ophthalmologist on outcome were collected.

Results Patients traveled a median 36.5 miles (IQR:20-85). Median time from onset was 210 days (IQR:70-1100). Median time from referral to visit was 34 days (IQR:7-86), with peaks at one week (urgent requests) and 3 months. 82% (247/300) were complex/very complex. 81% (242/300) were appropriate referrals. Median number of previous providers seen was 2 (IQR:2-4; range:0-10). 40% (119/300) were misdiagnosed; 49% (147/300) were at least partially misdiagnosed; 7% (22/300) had unknown diagnoses. Women were more likely to be at least partially misdiagnosed—57% (87/153) versus 35% (39/112) of men. Mismanagement or delay in care was present in 28% (85/300), unnecessary tests in 19% (56/300), unnecessary consultations in 22% (65/300), and imaging misinterpretation in 15% (6/300). In 59% (178/300) neuro-ophthalmologists provided a diagnosis and directed treatment, and in 21% (62/300) neuro-ophthalmologists played a major role in preserving vision/preventing life-threatening complications/avoiding harmful treatment.

Conclusions Most referrals to neuro-ophthalmologists were appropriate, but many were delayed. Misdiagnosis prior to referral was common. Neuro-ophthalmologists often prevented vision and life-threatening complications.

Authors/Disclosures
Leanne Stunkel, MD (Washington University in St. Louis) PRESENTER	Dr. Stunkel has nothing to disclose.
Devin D. Mackay, MD, FAAN (Indiana University)	Dr. Mackay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Optum. Dr. Mackay has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for various law firms.
Beau B. Bruce, MD, FAAN (Centers for Disease Control & Prevention)	Dr. Bruce has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Bayer.
Nancy J. Newman, MD, FAAN (Emory University School of Medicine)	Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurophth. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lilly. The institution of Dr. Newman has received research support from GenSight. The institution of Dr. Newman has received research support from Santhera. The institution of Dr. Newman has received research support from NINDS/NIH. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care.
Valerie Biousse, MD	Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Topcon. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.

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