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Updated: Sep 3, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Current diagnosis and treatment practice of central retinal artery occlusion: results from a survey among German
Carolin Hoyer1, Simon Winzer2,3, Egbert Matthé4
1Department of Neurology and Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. carolin.hoyer@umm.de.
Insights
Central retinal artery occlusion (CRAO) care varies significantly in German stroke units. Neurologists often manage CRAO as an acute stroke, highlighting the need for standardized interdisciplinary evaluation.
Area of Science:
- Ophthalmology
- Neurology
- Emergency Medicine
Background:
- Central retinal artery occlusion (CRAO) is a critical neuro-ophthalmological emergency.
- Current management strategies and guidelines for CRAO are not well-established, leading to varied clinical practices.
Purpose of the Study:
- To investigate the early evaluation, diagnostic, and acute treatment approaches for CRAO in German hospitals with stroke units.
- To characterize current practices in emergency department care for patients with unilateral vision loss (UVL) due to CRAO.
Main Methods:
- An anonymous online survey was distributed to 335 certified German stroke units in July 2021.
- The survey focused on emergency department organization, diagnostic procedures, and treatment protocols for UVL/CRAO patients.
- 163 centers (48.6%) responded to the survey.
Main Results:
- Most UVL patients (86.7%) were treated as emergencies, but only 44.9% followed specific guidelines.
- Neurologists led initial evaluations in 62.5% of hospitals, while ophthalmologists did so in 31.6%.
- Thrombolysis was performed in 57.4% of cases, and 94.8% of CRAO patients admitted to neurology were treated on a stroke unit.
Conclusions:
- Significant heterogeneity exists in the early hospital care of CRAO within German stroke units.
- Neurologists frequently manage CRAO as an acute stroke, indicating a need for improved interdisciplinary collaboration.
- Standardizing emergency evaluation protocols is crucial for future clinical trials and improved patient outcomes.
Background:
Central retinal artery occlusion (CRAO) is a neuro-ophthalmological emergency whose optimal management is still under debate and due to the absence of definite guidelines, practice is expected to vary. We aimed to characterize early evaluation as well as acute treatment and diagnostic approaches in German hospitals with a stroke unit (SU).
Methods:
In 07/2021, all 335 certified German SUs were invited to participate in an anonymous online survey endorsed by the German Stroke Society on emergency department care organization, diagnostic procedures, and treatment of patients with unilateral vision loss (UVL) subsequently diagnosed with CRAO.
Results:
One hundred and sixty-three (48.6%) of the 335 eligible centers responded. Most (117/135; 86.7%) stated that UVL patients were treated as an emergency, in 62/138 (44.9%) hospitals according to specific guidelines. First-line evaluation was performed by neurologists in 85/136 (62.5%) hospitals, by ophthalmologists in 43/136 (31.6%) hospitals. Seventy of 135 (51.9%) respondents indicated a lack of on-site ophthalmological expertise. Seventy-four of 129 (57.4%) respondents performed thrombolysis in CRAO and 92/97 (94.8%) stated that patients with CRAO-if admitted to neurology-were treated on a SU.
Conclusions:
Our findings reflect notable heterogeneity in early intrahospital care of CRAO in German SUs but demonstrate a preference for work-up and management as acute stroke by the involved neurologists. Streamlining interdisciplinary emergency evaluation is essential for ongoing and future prospective trials.
