Objective : This study aimed to identify challenges in the management of neuro–immunological diseases at an acute care hospital without an ophthalmology department by examining the status of collaboration with nearby ophthalmology clinics.
Participants and Methods : A total of 1,174 patients referred from ophthalmology clinics between January 2019 and November 2023 were retrospectively reviewed, and 1,089 patients were included in the analysis. The following variables were evaluated : referring institutions, chief complaints, clinical diagnoses, number of days from symptom onset to ophthalmology consultation, and number of days from ophthalmology consultation to hospital visit.
Results : The most frequent chief complaint was diplopia (314 cases, 28.8%), followed by visual field defects (215 cases, 19.7%) and decreased visual acuity (169 cases, 15.5%). The major clinical diagnoses associated with diplopia were cranial nerve palsy (100 cases, 31.8% ; 97 with single–nerve palsy, 3 with multiple–nerve palsies), myasthenia gravis (17 cases, 5.4%), and cerebrovascular disease (14 cases, 4.5%). Among patients with visual field defects, the primary diagnosis was cerebrovascular disease (44 cases, 20.5%), and idiopathic optic neuritis was identified in three cases (1.4%). In cases presenting with decreased visual acuity, cerebrovascular disease was the most common diagnosis (34 cases, 20.1%), while multiple sclerosis, neuromyelitis optica spectrum disorder, or idiopathic optic neuritis were identified in eight cases (4.7%). Patients with decreased visual acuity had a significantly longer median interval from symptom onset to hospital visit (7.0 days) compared with those with visual field defects (4.0 days).
For patients with decreased visual acuity within 14 days of onset, ophthalmology clinics were categorized into two groups based on their annual number of referrals (≥3 vs. <3). Clinics with a higher referral volume had a significantly greater proportion of facilities whose median referral time to our hospital was within seven days compared with clinics with lower referral volume (92.3% vs. 50.0%, p = 0.035).
Discussion : Close collaboration with ophthalmology clinics is essential for the appropriate management of neuro–immunological diseases. In particular, targeted measures are needed for cases presenting with decreased visual acuity, which tend to experience delays in referral and diagnosis.
