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The Use of Retinal Photography in Nonophthalmic Settings and Its Potential for Neurology

Pérez, Mario A. MD*; Bruce, Beau B. MD, MS*,†; Newman, Nancy J. MD*,†,‡; Biousse, Valérie MD*,†

doi: 10.1097/NRL.0b013e318272f7d7
Review Articles

Background: Ocular fundus examination is an important element of the neurological examination. However, direct ophthalmoscopy is difficult to perform without pupillary dilation and requires extensive practice to accurately recognize optic nerve and retinal abnormalities. Recent studies have suggested that digital retinal photography can replace direct ophthalmoscopy in many settings.

Review Summary: Ocular fundus imaging is routinely used to document and monitor disease progression in ophthalmology. Advances in optical technology have made it easier to obtain high-quality retinal imaging, even without pupillary dilation. Retinal photography has a high sensitivity, specificity, and interexamination/intraexamination agreement compared with in-person ophthalmologist examination, suggesting that photographs can be used in lieu of ophthalmoscopy in many clinical situations. Nonmydriatic retinal photography has recently gained relevance as a helpful tool for diagnosing neuro-ophthalmologic disorders in the emergency department. In addition, several population-based studies have used retinal imaging to relate ophthalmic abnormalities to the risk of hypertension, renal dysfunction, cardiovascular mortality, subclinical and clinical stroke, and cognitive impairment. The possibility of telemedical consultation offered by digital retinal photography has already increased access to timely and accurate subspecialty care, particularly for underserved areas.

Conclusions: Retinal photography (even without pupillary dilation) has become increasingly available to medical fields outside of ophthalmology, allowing for faster and more accurate diagnosis of various ocular, neurological, and systemic disorders. The potential for telemedicine may provide the additional benefits of improving access to appropriate urgent consultation in both clinical and research settings.

Departments of *Ophthalmology


Neurological Surgery, Emory University, Atlanta, GA

Supported in part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, and by NIH/NEI core grant P30-EY06360 (Department of Ophthalmology). B.B.B. receives research support from the NIH/NEI (K23-EY019341). N.J.N. is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award. M.A.P. receives support from a scholarship-loan program by COLFUTURO (Bogotá DC, Colombia).

The authors declare no conflict of interest.

Reprints: Valérie Biousse, MD, Neuro-Ophthalmology Unit, Emory Eye Center, The Emory Clinic, 1365-B Clifton Road NE, Atlanta, GA 30322. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.