Central Retinal Artery Occlusion at a Canadian Academic Center

Central retinal artery occlusion (CRAO) is a retinal stroke with poor visual prognosis and frequent association with life-threatening conditions. Clinical guidelines and treatment options are in evolution, and Canadian data regarding CRAO are limited.

Patients with CRAO between June 1, 2019, and May 31, 2023, were included. The medical chart was reviewed for demographics, presentation factors, investigations, interventions, secondary prevention referrals and outcomes.

Seventy-six patients were included. Median age was 68.1 (61.4-81.8) years, and 60.5% were male. The site of presentation was an emergency department in 61.8%. The median (interquartile range [IQR]) time from vision loss to presentation was 15.0 (3.5-48.0) hours; 28.9% presented within 4.5 hours. The median (IQR) time for ophthalmological consultation was 12.0 (4.6-22.6) hours. No patient was treated with thrombolysis. Referral for neurovascular secondary prevention occurred for 92.1%; however, referral for ocular follow-up was omitted in 21.1%. Among patients with non-arteritic CRAO, 25.7% had symptomatic carotid stenosis, and 10.5% had a cardioembolic source. Giant cell arteritis was diagnosed in 8.1% of patients over age 50. Functional visual recovery occurred for 10.5% of patients.

In this series, patients often presented within hours of CRAO and usually to an emergency department; however, no patient was treated with thrombolysis. As in other centers, delay in ophthalmological consultation and the lack of a defined CRAO treatment pathway are barriers. Patients with CRAO frequently have high-risk underlying pathology and generally do not experience meaningful improvement in vision. There is an unmet need for Canadian guidelines to standardize multidisciplinary care for CRAO.