Utility of Ophthalmic Exam Under Anaesthesia in Adult Patients With Intellectual Disability

BACKGROUND: While ophthalmic exam under anaesthesia (EUA) is well-described in the paediatric patient population, it is rarely performed on adult patients. Ophthalmic EUA is often necessary for accurate diagnosis and management in adults with intellectual disability due to inability to tolerate an outpatient eye exam. This paper is a retrospective chart review aiming to explore the diagnostic and therapeutic benefits of ophthalmic EUA in patients with intellectual disability. METHODS: This study is a retrospective chart review of all adult patients with intellectual disability who underwent an ophthalmic EUA at our rural academic centre from 1 April 2015 to 1 April 2025. Thirty-eight exams on 15 different patients met the inclusion criteria. RESULTS: 21.1% of exams resulted in a new diagnosis, and 44.7% of exams resulted in a change in eye care management, including procedural intervention during the EUA, subsequent surgical procedures or alterations of the eyedrop regimen. None of our patients experienced postoperative complications following EUA. However, two patients had complicated postoperative courses following subsequent cataract or retina surgery. CONCLUSIONS: In both our series and the previously published literature, EUA proved instrumental in the proper ophthalmic management of patients who are unable to tolerate an outpatient eye exam. However, the risks and benefits of the procedure should be carefully discussed with patients and their caregivers/medical decision makers before proceeding with anaesthesia, as this patient population is at higher risk of anaesthesia complications than their age-matched peers.