• Sidra Zafar, Krisztian Sebestyen, Zaid Qureshi, Oliver Schein, Pamela Johnson, Divya Srikumaran, and Fasika A Woreta.
• Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
• Am. J. Ophthalmol. 2020 Mar 1; 211: 114-122.

PurposeTo identify nationwide trends and factors associated with advanced imaging (computed tomography [CT] and magnetic resonance imaging [MRI]) use for eye-related emergency department (ED) visits.DesignRetrospective, trend study.MethodsSetting: National Hospital Ambulatory Medical Care Survey 2007-2015.Patient PopulationEye-related ED patients who underwent CT or MRI.Main Outcome Measure(S)Population-based CT/MR imaging rates and independent factors associated with imaging.ResultsAn estimated 7 million eye-related ED visits occurred between 2007 and 2015. Adjusted for annual eye-related ED visits, the rate of imaging use rose 94%, from 121.7 per 1,000 eye-related ED visits in 2007 to 236.0 per 1,000 eye-related ED visits in 2015. 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 accounted for 73.2% of all visits where imaging was performed. On multivariable analysis, older patients (odds ratio [OR] = 1.02, 95% confidence interval [CI] 1.01-1.03) and females (OR=2.07, 95% CI 1.18-3.63) were more likely to undergo imaging than younger patients and males. Imaging was also more likely to be performed for Medicare beneficiaries (OR=2.12, 95% CI 1.08-4.15) than for privately insured patients. Patients who were admitted to the hospital were 6 times more likely (OR=6.39, 95% CI 2.04-20.0) to undergo imaging than those who were not admitted.ConclusionsAdvanced imaging for eye-related ED visits has escalated at a higher rate than ED visits for eye complaints. Future studies to develop evidence-based algorithms for use of CT/MR imaging for eye complaints that can help balance benefits against financial costs and health risk are warranted.Copyright © 2019 Elsevier Inc. All rights reserved.

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