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The source of embolism in amaurosis fugax and retinal artery occlusion
R L Smit1, G S Baarsma, P J Koudstaal
1Eye Hospital Rotterdam, The Netherlands.
Insights
For suspected retinal embolism, carotid artery duplex scanning is more effective than extensive cardiac screening. This diagnostic approach helps identify the cause of amaurosis fugax or retinal artery occlusion.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Retinal embolism can cause vision loss, including amaurosis fugax and retinal artery occlusion.
- Determining the source of embolism is crucial for appropriate patient management and stroke prevention.
Purpose of the Study:
- To evaluate the diagnostic yield of cardiac screening versus carotid artery duplex scanning in patients with suspected retinal embolism.
Main Methods:
- A study of 41 consecutive patients presenting with amaurosis fugax or retinal artery occlusion.
- Involved extensive cardiac investigations (ECG, Holter, echocardiography) and carotid artery duplex scanning.
Main Results:
- No cause was identified in 66% of patients.
- Carotid artery stenosis or occlusion was the likely cause in 27% of cases.
- Cardiac sources of embolism were identified in only 2% of patients.
Conclusions:
- Carotid artery duplex scanning is more informative than extensive cardiac screening for diagnosing the cause of amaurosis fugax or retinal artery occlusion in this patient group.
- Prioritizing carotid imaging can improve diagnostic efficiency and guide treatment decisions.
Abstract:
To assess the diagnostic value of an extensive cardiac screening and of carotid artery duplex scanning in patients suspected of suffering from retinal embolism, we examined 41 consecutive patients (mean age 59.6 years, range 36-74) who presented either with amaurosis fugax or with a retinal artery occlusion. In spite of extensive investigations, we found no cause in 27 patients (66%). In 11 patients (27%), symptoms were likely to be due to a stenosis or an occlusion of the ipsilateral carotid artery. In only 1 patient (2%), the heart was likely to be a source of embolism. We conclude that in patients in this age group suffering from either amaurosis fugax or a retinal artery occlusion, a carotid artery duplex scanning should be performed first as this investigation is more likely to provide useful information than an extensive cardiac screening (ECG, Holter 24-hour monitoring and precordial echocardiography).