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Central retinal artery occlusion: a retrospective study of disease presentation, treatment, and outcomes
Meghan J Smith1, Matthew D Benson1, Matthew Tennant1
1Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
Insights
Central retinal artery occlusion (CRAO) often presents late, missing thrombolysis windows. Public awareness and prompt eye care are crucial for improving outcomes in these patients with significant vascular risk factors.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Central retinal artery occlusion (CRAO) is an ocular stroke with poor visual prognosis.
- CRAO shares pathophysiology with cerebral stroke but has unique clinical challenges.
- Variability in clinical practice necessitates studies on CRAO presentation, treatment, and outcomes.
Purpose of the Study:
- To assess the presentation, treatment, and outcomes of CRAO at a Canadian tertiary care center.
- To identify areas for improvement in the management of CRAO patients.
- To analyze the time to presentation and treatment modalities for CRAO.
Main Methods:
- Retrospective review of 27 patients diagnosed with CRAO over two years (March 2018-March 2020).
- Data collected on patient presentation, initial point of care, visual acuity, etiology, vascular risk factors, and interventions.
- Analysis of systemic comorbidities and secondary cerebrovascular events.
Main Results:
- Most CRAO patients (51.8%) presented to eye care providers; only 11.1% presented within 4.5 hours.
- 81% had severe vision loss (20/400 or worse) at presentation; no patients received thrombolysis.
- Nonarteritic etiology was common (92.6%), all patients had vascular risk factors, and 18.5% had ipsilateral carotid stenosis.
Conclusions:
- Late presentation to eye care providers and emergency departments hinders timely thrombolysis for CRAO.
- Public awareness campaigns are needed to improve early recognition and treatment of CRAO.
- CRAO patients exhibit high rates of systemic comorbidities, emphasizing the need for comprehensive vascular risk management.
Objective:
A central retinal artery occlusion (CRAO) represents a form of ocular stroke with poor visual prognosis. CRAO shares a common pathophysiology with cerebral ischemic stroke but presents unique diagnostic and management challenges leading to variability in clinical practice. This study aims to assess the presentation, treatment, and outcomes of CRAO at a tertiary care centre in Canada over 2 years and elucidate potential areas for improvement in the care of these patients.
Methods:
Single-institution retrospective review including 27 patients diagnosed with CRAO from March 2018 to March 2020 in Edmonton, Alberta.
Results:
Most patients with CRAO presented to eye care providers (14 of 27); others presented to the emergency department (10 of 27) or family physicians (2 of 27). Three patients (11.1%) presented within 4.5 hours of symptom onset. At presentation, 81% of patients had visual acuity of 20/400 or worse in the affected eye. No patients received thrombolysis. The majority of CRAO cases had a nonarteritic etiology (92.6%). All patients had at least one pre-existing vascular risk factor. Forty-eight percent of patients received escalated medical therapy. Ipsilateral carotid stenosis was identified in 5 patients (18.5%); 3 patients required carotid endarterectomy. Two patients were diagnosed with atrial fibrillation. Two patients experienced symptomatic cerebral ischemia within 6 weeks of CRAO.
Conclusions:
The majority of patients with CRAO presented to eye care providers, and few present within the potential window for thrombolysis of 4.5 hours, highlighting the need for public awareness strategies. Our cohort highlights the significant rate of systemic comorbidity that exists in these patients.
