Screening for Ocular Candidiasis Among Patients With Candidemia: Is It Time to Change Practice?

Bringing our perspectives as infectious diseases physicians and ophthalmologists, we address controversies and offer opinions about screening candidemic patients for ocular candidiasis. Ocular candidiasis (OC) complicates approximately 10% of candidemia and carries potentially severe morbidity. There are conflicting recommendations about the need for routine funduscopic examinations of candidemic patients. Indirect funduscopy is accurate and safe in diagnosing OC, and positive findings change recommended treatment. However, conclusive evidence that treatment changes improve outcomes is lacking. Bringing perspectives as infectious diseases physicians and ophthalmologists, we review controversies about OC and endorse routine screening during candidemia. We acknowledge difficulties in obtaining inpatient ophthalmologic consults and recommend studies to evaluate digital fundus photography and teleophthalmology as an alternative to funduscopic examinations by ophthalmologists in asymptomatic patients.

Automated summary

This article discusses the controversy surrounding the screening of candidemic patients for ocular candidiasis, highlighting the accuracy and safety of indirect funduscopy in diagnosis and the potential impact of positive findings on treatment recommendations. However, the lack of conclusive evidence on the effectiveness of treatment changes in improving outcomes is acknowledged. The authors endorse routine screening and suggest exploring digital fundus photography and teleophthalmology as alternatives to inpatient ophthalmologic consultations in asymptomatic patients.