Written by Jonathan Brewer
Spoon Feed
Ocular POCUS by emergency clinicians is highly accurate for diagnosing retinal detachment.
Trust your eyes
This article consists of three systematic reviews and meta-analyses evaluating ocular POCUS for retinal detachment diagnosis in the ED setting.
The first meta-analysis (Vrablik et al.) included four low-bias studies with 201 total patients and reported sensitivity of 97–100% and specificity of 83–100%, though data were not pooled due to heterogeneity in operator experience and outcome definitions. The second (Gottlieb et al.) included 11 studies with 844 patients, finding a pooled sensitivity of 94.2%, specificity of 96.3%, positive LR of 25.2, and negative LR of 0.06 — with no significant difference in performance between ED and non-ED providers. The third (Propst et al.) included nine studies restricted to emergency physicians, yielding a pooled sensitivity of 94%, specificity of 94%, positive LR of 11.7, and negative LR of 0.11. Overall, the sensitivity ranges from 94–100% with a specificity of 83–100% and a negative likelihood ratio ranging from 0.06–0.25.
Of note, typical limitations such as operator skill heterogeneity exist, and no study assessed patient-oriented outcomes like final visual acuity. Also, the literature base behind emergency physicians determining a macula-on vs. macula-off RD is still very limited, so urgent ophthalmology follow-up is still warranted in all cases.
How does this change my practice?
Ocular POCUS is already part of my toolkit for the undifferentiated eye complaint, and this review reinforces why. We are becoming increasingly more facile with POCUS with each passing year, but it is still important to remember when to call a consultant. Use POCUS for the diagnosis of a RD, but be wary of determining a “mac-on” vs. “mac-off” RD unless you feel confident with your skills.
Source
What is the Utility of Point-of-care Ultrasound for Diagnosing Retinal Detachment? J Emerg Med. 2026 Jul;86:204-210. doi: 10.1016/j.jemermed.2026.04.023. Epub 2026 May 1. PMID: 42176469.
