Ocular fundus examination in emergency medicine: an Australian survey of equipment, training, current practice, and clinician perceptions

OBJECTIVES: Fundus examination is critical for the early detection of serious ocular and neurological conditions in the emergency department (ED), yet it remains underused. This study aimed to investigate the current practice of fundus examination among ED doctors in Australia. METHODS: A national cross-sectional online survey was distributed to the Australasian College for Emergency Medicine members. The 28-item questionnaire assessed demographics, equipment availability, training, confidence, practice patterns, perceived barriers and image-interpretation performance using five representative fundus images. Descriptive statistics and logistic regression were used for analysis. RESULTS: A total of 135 emergency clinicians completed the base items (58.5% female; median experience, 10 years [interquartile range 5.5-20]; 25.9% from regional/remote areas). Most respondents had access to direct ophthalmoscopes (94.5%) or slit lamps (63.7%), while a few had retinal cameras (10.4%). Although 42.2% clinicians had received related training in EDs, over half of them receiving it less than once every five years. While 82.1% of clinicians considered fundus examination important, there was poor agreement on appropriate indications, and only 50.8% reported performing it themselves when indicated. Only 26.5% doctors expressed confidence in performing and interpreting fundus examinations. Image-interpretation accuracy across images was 44.5% (95% CI, 38.5-50.7%). Doctors most reported low confidence, insufficient training as barriers, while enhanced training and portable cameras were the key suggested enablers. CONCLUSION: Underutilisation of fundus examination in EDs highlights gaps in training, standardised indications, confidence, image-interpretation performance and equipment usability. Addressing these barriers is key to improving neuro-ophthalmic triage and early detection of sight-threatening and life-threatening conditions.