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Published on: March 26, 2020
Central retinal artery occlusion - detection score
Maria Casagrande1, Nils Alexander Steinhorst1, Susanne Kathrin Dippel2
1Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Insights
A questionnaire-based Central Retinal Artery Occlusion (CRAO)-Detection Score effectively identifies CRAO patients. This tool aids in timely diagnosis and treatment of acute visual loss, crucial for effective therapies.
Area of Science:
- Ophthalmology
- Medical Diagnostics
- Retinal Vascular Diseases
Background:
- Central Retinal Artery Occlusion (CRAO) is a critical cause of acute visual loss.
- Early diagnosis and treatment of CRAO are essential for preserving vision.
- Current diagnostic methods may require specialized equipment and expertise.
Purpose of the Study:
- To evaluate the diagnostic accuracy of a novel CRAO-Detection Score using a questionnaire.
- To determine the sensitivity and specificity of the score without requiring fundoscopy.
- To assess the potential of the score in triaging patients with acute visual loss.
Main Methods:
- A prospective study involving 176 emergency patients with acute visual loss.
- Administration of a six-questionnaire prior to ophthalmologic examination.
- Utilizing LASSO penalized multivariate logistic regression and ROC analysis for statistical evaluation.
Main Results:
- The CRAO-Detection Score achieved an Area Under the Curve (AUC) of 0.9 via ROC analysis.
- A simplified two-question score (Short CRAO-Detection Score) showed a comparable AUC of 0.88.
- The Short CRAO-Detection Score identified CRAO patients effectively, with a low false positive rate.
Conclusions:
- A questionnaire-based CRAO-Detection Score can effectively detect a significant percentage of CRAO cases.
- This score shows promise as a triage tool for patients presenting with acute visual loss.
- Timely triage is vital, given the time-dependent nature of effective treatments like intravenous fibrinolysis.
Purpose:
To investigate the sensitivity and specificity of central retinal artery occlusion (CRAO)-Detection Score in diagnosing CRAO via questionnaire and without fundoscopy.
Methods:
This prospective study enrolled 176 emergency patients suffering from acute visual loss, of whom 38 were suffering from CRAO. Before conducting any examination, we administered our questionnaire containing six questions, followed by a thorough ophthalmologic examination to make the diagnosis. Statistical analysis involved a LASSO penalised multivariate logistic regression model.
Results:
Our receiver operating characteristic (ROC) analysis based on a LASSO penalised multivariate logistic regression model showed an area under the curve (AUC) of 0.9 - three out of six questions were selected by LASSO. Interestingly, the unweighted ROC analysis of only two questions (Short CRAO-Detection Score) yielded similar results with an AUC of 0.88. The short CRAO-Detection Score of 2 yielded 14% (4/28) false positive patients.
Conclusion:
This prospective study demonstrates that a high percentage of CRAO patients are detectable with a questionnaire. The CRAO-Detection Score might be used to triage patients suffering acute visual loss, which is important as intravenous fibrinolysis seem to be time-dependent to be effective.
