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Updated: Jun 17, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
21.9K
Eye stroke protocol in in the emergency department.
Étienne Bénard-Séguin1, Fadi Nahab2, Andrew M Pendley3
1Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
Summary
Rapid diagnosis of retinal artery occlusions (RAO) using non-mydriatic fundus photography with optical coherence tomography (NMFP-OCT) in emergency departments improves patient outcomes. This combined approach aids in early stroke alerts and treatment initiation.
Area of Science:
- Ophthalmology
- Emergency Medicine
- Stroke Management
Background:
- Acute Retinal Artery Occlusions (RAO) have poor visual outcomes due to delayed diagnosis.
- Standard emergency departments (ED) lack optical coherence tomography (OCT) for hyper-acute RAO detection.
- Non-mydriatic ocular fundus photographs (NMFP) combined with OCT can facilitate rapid remote diagnosis.
Purpose of the Study:
- To evaluate the utility of NMFP-OCT for ultra-rapid remote diagnosis of acute central and branch retinal artery occlusions (CRAO/BRAO) in the ED.
- To assess the feasibility of initiating a stroke alert and treatment protocol for acute vision loss using NMFP-OCT.
Main Methods:
- Prospective evaluation of CRAO/BRAO patients undergoing NMFP-OCT in a general ED.
- Data collection on presentation time, NMFP-OCT performance time, and diagnostic findings.
- Remote diagnosis and treatment initiation based on NMFP-OCT results.
Main Results:
- 22 CRAO and 4 BRAO patients diagnosed over one year.
- NMFP-OCT performed within an average of 141 minutes of ED presentation.
- Remote diagnosis within 4.5 hours enabled thrombolysis in 2 patients.
- OCT revealed inner retinal hyper-reflectivity/edema in all cases within 12 hours, even with subtle fundus findings.
Conclusions:
- NMFP-OCT implementation in general EDs facilitates rapid remote diagnosis of acute RAO.
- This approach enables prompt initiation of an eye stroke protocol.
- OCT enhances diagnostic accuracy in hyperacute RAO with near-normal fundi, complementing traditional photography.
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