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Telemedicine for Acute Monocular Visual Loss: A Retrospective Large Telestroke Network Experience
Oana M Dumitrascu1, Stephen English2, Nour Alhayek1
1Department of Neurology, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona, USA.
Summary
Central retinal artery occlusion (CRAO) diagnosis via telestroke is suboptimal. Patients eligible for reperfusion therapy may miss treatment opportunities due to current telestroke limitations.
Area of Science:
- Ophthalmology
- Neurology
- Telemedicine
Background:
- Central retinal artery occlusion (CRAO) is an under-recognized stroke subtype.
- Hyperacute reperfusion therapies may benefit CRAO patients.
- Telestroke networks are expanding for stroke care.
Purpose of the Study:
- To evaluate telestroke activations for CRAO diagnosis and thrombolysis.
- To assess the effectiveness of telestroke in managing acute visual loss.
- To identify limitations in current telestroke protocols for CRAO.
Main Methods:
- Retrospective observational study of acute visual loss encounters (2010-2021).
- Multicentric Mayo Clinic Telestroke Network data analysis.
- Collection of demographics, time to evaluation, ocular findings, and recommendations for CRAO patients.
Main Results:
- 0.51% of 9,511 telestroke encounters were for acute ocular complaints.
- Five patients had possible CRAO, with four presenting within 4.5 hours.
- No patients received thrombolytic therapy; all were referred for ophthalmology consultation.
Conclusions:
- Current telestroke assessment for acute visual loss is suboptimal.
- Patients eligible for reperfusion therapy may not receive timely treatment.
- Teleophthalmology and advanced ophthalmic tools are needed to enhance telestroke systems.
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