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Published on: March 26, 2020
A Remote Consult Retinal Artery Occlusion Diagnostic Protocol
Gareth M C Lema1, Reade De Leacy2, Michael G Fara2
1Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York; James J. Peters VA Medical Center, Bronx, New York.
Purpose:
To report a novel protocol for diagnosis of retinal artery occlusions at the point of care using OCT and a remote consult model.
Design:
Retrospective case series and evaluation of a diagnostic test or technology.
Participants:
Adult patients who presented with painless monocular vision loss and were diagnosed with a nonarteritic retinal artery occlusion.
Methods:
OCT machines were placed in the stroke center or emergency department at 3 hospitals within our health system. Patients who presented with painless monocular vision loss were evaluated by the stroke neurology service and an OCT was acquired. The images were interpreted remotely by the retina service. An in-house ophthalmology consult was not required to make the final treatment decision. Eligible patients were treated with intra-arterial tissue plasminogen activator (IA-tPA). Patients were followed by ophthalmology during their admission when an in-house consultation service was available or otherwise evaluated immediately after discharge.
Main Outcome Measures:
Visual acuity (VA) before and after treatment with IA-tPA; time from last known well (LKW) to treatment; and time from presentation to treatment.
Results:
In the first 18 months since the protocol went live, 59 patients were evaluated. Twenty-five patients (42%) had a confirmed retinal artery occlusion based on OCT and follow-up examination. Ten patients were eligible for treatment, and 9 patients received treatment with IA-tPA. There was a statistically significant improvement in mean VA from logarithm of the minimum angle of resolution (logMAR) 2.14 to logMAR 0.7 within 24 hours after treatment (P = 0.0001) and logMAR 1.04 after 4 weeks (P = 0.01). Clinically significant improvement was noted in 66% of patients within 24 hours and maintained through 1 month in 56% of all treated patients. The mean time to treatment from LKW was 543 minutes and from presentation at the stroke center was 146 minutes.
Conclusions:
We report the successful implementation of a remote consult protocol using point-of-care automated OCT. This novel paradigm demonstrates the potential utility of remote consult services for the diagnosis of time-sensitive ophthalmic emergencies.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found after the references.
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