Diagnosing Central Retinal Artery Occlusion (CRAO) without Fundus Examination

Abstract

In the field of ophthalmology, central retinal artery occlusion is still one of the unsolved pathologies, as there is no widely accepted evidence-based therapeutic concept. Meta-analysis suggests that intravenous fibrinolysis might help to improve the outcome if performed within the first 4.5 hours after symptom onset. However, this short window of opportunity is often missed due to delays during diagnostic testing (e.g. time elapsed before performance of an ophthalmological examination) or patient-processing (referring the patient to a specialized medical facility). This article presents a diagnostic tool in the form of a simple questionnaire, comprising a medical history and examinations, which could help to minimize the time required to initiate the appropriate treatment.

Key words

central retinal artery occlusion (CRAO) - diagnostic tool - REVISION study

^* First authors.

Publication History

Received: 03 March 2021

Accepted: 21 September 2021

Article published online:
15 December 2021

• Literatur/References

• 1 Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol 2005; 140: 376-391
• 2 Mac Grory B, Nackenoff A, Poli S. et al. Intravenous Fibrinolysis for Central Retinal Artery Occlusion: A Cohort Study and Updated Patient-Level Meta-Analysis. Stroke 2020; 51: 2018-2025
• 3 Schrag M, Youn T, Schindler J. et al. Intravenous Fibrinolytic Therapy in Central Retinal Artery Occlusion: A Patient-Level Meta-analysis. JAMA Neurol 2015; 72: 1148-1154
• 4 Schultheiss M, Hartig F, Spitzer MS. et al. Intravenous thrombolysis in acute central retinal artery occlusion – A prospective interventional case series. PLoS One 2018; 13: e0198114
• 5 Lavin P, Patrylo M, Hollar M. et al. Stroke Risk and Risk Factors in Patients With Central Retinal Artery Occlusion. Am J Ophthalmol 2018; 196: 96-100
• 6 Lee J, Kim SW, Lee SC. et al. Co-occurrence of acute retinal artery occlusion and acute ischemic stroke: diffusion-weighted magnetic resonance imaging study. Am J Ophthalmol 2014; 157: 1231-1238
• 7 Wenzel DA, Kromer R, Poli S. et al. Optical coherence tomography-based determination of ischaemia onset – the temporal dynamics of retinal thickness increase in acute central retinal artery occlusion. Acta Ophthalmol 2021; 99: e247-e252
• 8 Ochakovski GA, Wenzel DA, Spitzer MS. et al. Retinal oedema in central retinal artery occlusion develops as a function of time. Acta Ophthalmol 2020; 98: e680-e684
• 9 Casagrande M, Kromer R, Wenzel DA. et al. Determination of Ischemia Onset Based on Automatically Generated Spectralis SD-OCT Values in Acute Central Retinal Artery Occlusion. J Ophthalmol 2021; 2021: 5527292