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Cited by 38Healthcare Systems and TechnologyOphthalmology and Visual Health ResearchOphthalmology and Eye Disorders

The DOI matches its Crossref record; 34 of the 36 references it cites were found in a registry or an index.

Referral Patterns in Neuro-Ophthalmology

Stunkel, Leanne, Mackay, Devin D., Bruce, Beau B., Newman, Nancy J., Biousse, Valérie·2020·Journal of Neuro-Ophthalmology
DOI 10.1097/wno.0000000000000846
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Abstract

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 the relatively small number of neuro-ophthalmologists, and consequently, patients may be affected by incorrect or delayed diagnosis. The objective of this study is to analyze referral patterns to neuro-ophthalmologists, characterize rates of misdiagnoses and delayed diagnoses in patients ultimately referred, and delineate outcomes after neuro-ophthalmologic evaluation. METHODS: Retrospective chart review of 300 new patients seen over 45 randomly chosen days between June 2011 and June 2015 in one tertiary care neuro-ophthalmology clinic. Demographics, distance traveled, time between onset and neuro-ophthalmology consultation (NOC), time between appointment request and NOC, number and types of providers seen before referral, unnecessary tests before referral, referral diagnoses, final diagnoses, and impact of the NOC on outcome were collected. RESULTS: Patients traveled a median of 36.5 miles (interquartile range [IQR]: 20-85). Median time from symptom onset was 210 days (IQR: 70-1,100). Median time from referral to NOC was 34 days (IQR: 7-86), with peaks at one week (urgent requests) and 13 weeks (routine requests). Median number of previous providers seen was 2 (IQR: 2-4; range:0-10), and 102 patients (34%) had seen multiple providers within the same specialty before referral. Patients were most commonly referred for NOC by ophthalmologists (41% of referrals). Eighty-one percent (242/300) of referrals to neuro-ophthalmology were appropriate referrals. Of the 300 patients referred, 247 (82%) were complex or very complex; 119 (40%) were misdiagnosed; 147 (49%) were at least partially misdiagnosed; and 22 (7%) had unknown diagnoses. Women were more likely to be at least partially misdiagnosed-108 of 188 (57%) vs 39 of 112 (35%) of men (P < 0.001). Mismanagement or delay in care occurred in 85 (28%), unnecessary tests in 56 (19%), unnecessary consultations in 64 (22%), and imaging misinterpretation in 16 (5%). Neuro-ophthalmologists played a major role in directing treatment, such as preserving vision, preventing life-threatening complications, or avoiding harmful treatment in 62 (21%) patients. CONCLUSIONS: Most referrals to neuro-ophthalmologists are appropriate, but many are delayed. Misdiagnosis before referral is common. Neuro-ophthalmologists often prevent vision- and life-threatening complications.

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Crossref · 10.1097/wno.0000000000000846

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  • Up to 40% of patients referred to a neuro-ophthalmology subspecialty service are misdiagnosed.

    “For example, up to 40% of patients referred to a neuro-ophthalmology subspecialty service are misdiagnosed,23 and similar referral patterns are observed in ocular oncology.24”

    From Evaluating the Performance of ChatGPT in Ophthalmology (2023) · cites this paper as [23]

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Research works printed but not linked: 1

  1. 2018, Revisions to payment policies under the Medicare physician fee schedule, quality payment program and other revisions to part B for CY 2019: proposed rules, Fed Regist., 83, 35704

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Metadata

Authors
Stunkel, L., Mackay, D. D., Bruce, B. B., Newman, N. J., & Biousse, V.
Affiliations
Emory University (US)
Corresponding author
Biousse, Valérie
ORCID
Venue
Journal of Neuro-Ophthalmology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-10-13
Volume
40
Issue
4
Pages
485-493
ISSN
1070-8022 (ISSN-L)
DOI
10.1097/wno.0000000000000846
OpenAlex
W2980543433
Cited by
37
References
36
Citations by year
2026: 6 · 2025: 6 · 2024: 4 · 2023: 7 · 2022: 5 · 2021: 7 · 2020: 2
FWCI
4.91
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Neuro-Ophthalmology (publishedVersion)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
National Institute of Neurological Disorders and Stroke (R01NS089694)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Technology
  • Health Sciences › Medicine › Ophthalmology › Ophthalmology and Visual Health Research
  • Health Sciences › Medicine › Ophthalmology › Ophthalmology and Eye Disorders
Keywords
misdiagnosis, delayed diagnosis, unnecessary testing, patient travel distance, time to diagnosis, ophthalmology referral, patient outcomes, health care access disparities
MeSH terms
Female, Humans, Male, Middle Aged, Neurology, Ophthalmology, Referral and Consultation, Retrospective Studies

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