Ocular fundus photos in the emergency room: a new application for telemedicine?

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This application proposes a research project and training plan to develop Beau B. Bruce, M.D. into an independent clinician-scientist in the area of acute neuro-ophthalmic disease. This proposal is a logical extension of Dr. Bruce's excellent academic background and early scientific efforts in the field of acute neuroophthalmic disorders, and is the next step toward gaining the experience and training that he needs to establish a successful independent clinical research career. His mentorship team will consist of David W. Wright, M.D. (co-mentor), Nancy J. Newman, M.D. (co-mentor), Roy W. Beck, M.D., Ph.D. (advisory committee), Val¿rie Biousse, M.D. (advisory committee), and Michael Lynn, M.S. (advisory committee) who have exceptional experience in a variety of overlapping areas that will provide synergistic guidance and support. Emory University provides an unrivaled environment for his short- and long-term career development. He will receive training through formal course work and structured mentorship in five major areas: (1) fundamentals of clinical research, (2) practicalities of multidisciplinary, multicenter clinical trials, (3) clinical interpretation of fundus photography, (4) advanced correlated/longitudinal data analysis, and (5) telemedicine. Dr. Bruce's research protocol recognizes that there is a critical disconnect between the diagnosis and treatment of acute neuro-ophthalmic diseases within existing clinical frameworks and seeks to explore the application of emerging telemedical technologies to close this gap in clinical practice and clinical research while advancing our knowledge of these emergent diseases. It will begin to address these issues through two specific aims: (1) assessing the impact and diagnostic capability of non-dilated ocular fundus photography on the diagnosis of papilledema among headache patients presenting to the emergency department, and (2) determining risk factors among headache patients predictive for the presence of papilledema and for poor visual outcomes from papilledema. Accomplishing these aims will likely provide a new approach to the diagnosis of papilledema and improve our prognostic capability and pathophysiologic understanding of papilledema. The successful completion of this research proposal and training plan will serve as the scientific foundation for Dr. Bruce's independent clinical research career in which he seeks to advance neuro-ophthalmic scientific knowledge, facilitate patient care, and execute clinical trials of promising therapies in the field of acute neuro-ophthalmic diseases.