Use of CT and MRI to diagnose eye problems in the ED skyrocketing, underlining need for guidance

The use of advanced imaging to diagnose and treat eye-related problems in the emergency department (ED) has nearly doubled in the U.S., intensifying the need for evidence-based protocols to guide such ordering.

Johns Hopkins researchers recently made that determination by scouring data from millions of ED visits conducted between 2007 and 2015. They found that the use of CT and MRI scans to diagnose eye-related ailments in the ED rose by about 94% during that period, according to their study, published in November’s American Journal of Ophthalmology.

While unable to assess the appropriateness of the tests, researcher Sidra Zafar believes this trend highlights the need for more standardized imaging procedures to treat patients with eye ailments.

“Advanced imaging for eye complaints in the emergent setting has escalated at a higher rate than ED visits for acute eye complaints,” concluded Zafar, with Hopkins’ Wilmer Eye Institute, and colleagues.” Evidence-based diagnostic algorithms may refine practice so providers avoid CT and MRI in patients for whom imaging will not add value to their care.”

Hopkins and experts drew their conclusions by reviewing data from 7 million eye-related ED visits, gathered by the National Center for Health Statistics. All told, the rate of imaging for such patients rose from about 122 per 1,000 eye-related ED visits in 2007, up to 236 per 1,000 visits in 2015.

About 73% of those encounters were for visual disturbances, contusion of the eye and/or adnexa, open globes and open wounds of ocular adnexa, diplopia, superficial corneal and/or conjunctival injuries, and orbital fractures. Older and female patients were more likely to receive a CT scan or MRI for eye issues when compared to their male or younger counterparts.

Medicare beneficiaries were also more likely to receive such imaging tests, which authors speculated was tied to fall injuries, a growing concern among the elderly population.

These findings come from a period when advanced imaging use was already escalating across the board, fueled by the growing prevalence of CT and MRI machines, and doctors fearful of malpractice suits, the authors wrote.

Zafar et al. noted that more research is needed to understand the diagnostic yields produced by ED eye imaging during this period of growth, as well as the underlying factors fueling this increase. In the meantime, they believe it’s important to develop evidence-based algorithms for the use of CT and MRI in ophthalmological care, “which can help balance benefits against financial costs and health risks.”

“Unnecessary testing contributes to escalating costs in a healthcare system that is already overburdened and reduces the availability of resources for other patients. Greater efforts are therefore needed to balance the risk-benefit ratio associated with overutilization of diagnostic imaging,” she wrote.