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Assessing Patients with Asymptomatic Retinal Emboli Detected at Retinal Screening
Afsara A Ahmmed1, Peter E Carey2, David H W Steel3,4
1The Medical School, Newcastle University, Newcastle upon Tyne, UK. a.a.ahmmed@newcastle.ac.uk.
Insights
Asymptomatic retinal emboli detected during diabetic retinopathy screening were linked to significant carotid artery stenosis (≥70%) in 23% of patients. This highlights the importance of screening protocols for identifying stroke risk and optimizing patient management.
Area of Science:
- Ophthalmology
- Cardiology
- Neurology
Background:
- Asymptomatic retinal emboli are associated with diabetes, carotid artery stenosis (≥70%), and stroke risk.
- Current guidelines for investigating and managing these patients are lacking.
- This study addresses the need for clear management pathways.
Purpose of the Study:
- To determine the incidence of significant carotid artery stenosis in patients with asymptomatic retinal emboli found during diabetic retinopathy screening.
- To evaluate current disease management strategies for these individuals.
Main Methods:
- Patients with new retinal emboli at screening were referred to a medical retinopathy clinic.
- Standardized examinations included carotid Doppler ultrasound and echocardiography.
- Retrospective review of case notes from January 2013 to April 2014.
Main Results:
- Retinal emboli were identified in 0.32% of screened individuals (44/13,643).
- Of 39 patients with available data, 23% had significant carotid artery stenosis.
- Medication changes occurred in 56% of patients; one underwent carotid endarterectomy, and eight received maximal medical therapy.
Conclusions:
- Significant carotid artery stenosis is a notable finding in patients with incident retinal emboli during screening.
- Established referral and investigation protocols effectively identify high-risk individuals for cerebrovascular events.
- Wider implementation of Doppler ultrasound and physician referral pathways is recommended.
Introduction:
Asymptomatic retinal emboli have been associated with diabetes, the presence of significant carotid artery stenosis (≥70%) and an increased risk of stroke. However, there is no clear guidance on how best to investigate and manage patients found to have asymptomatic retinal emboli. Therefore, this study aimed to assess the incidence of significant carotid artery stenosis in patients found to have asymptomatic retinal emboli at diabetic retinopathy screening, and to examine disease management approaches among these patients.
Methods:
Patients with new retinal emboli visible at diabetic retinopathy screening were referred to a medical retinopathy clinic and underwent examinations according to a standardized protocol, including carotid Doppler ultrasound and echocardiography. Case notes of patients referred between January 2013 and April 2014 were reviewed. Results of investigations, medication changes and the number of patients who underwent relevant surgical interventions were noted.
Results:
Retinal emboli were present in 44 of 13,643 people screened (0.32%). Full data were available for 39 patients. Twenty-two patients (56%) had relevant medication changes. Nine (23%) patients had significant carotid artery stenosis. One underwent carotid endarterectomy, and eight received maximal medical therapy.
Conclusion:
Significant carotid artery stenosis was not uncommon in patients with incident retinal emboli at retinal screening. The referral and investigation protocols identified individuals at risk of cerebrovascular events and led to optimized management. Pathways utilizing Doppler ultrasound and physician referral should be more widely implemented.
