Central Retinal Artery Occlusion
By Teddy Youn, et al
Central retinal artery occlusion (CRAO) is a devastating disease that commonly leads to blindness. Only 17% of patients with CRAO have a spontaneous meaningful recovery. Multiple causes can induce CRAO: carotid artery disease, cardiac valvular disease, atrial fibrillation, hypercoagulable disorders, and autoimmune diseases. Multiple empiric treatments have been used though with poor evidence for effectiveness. In addition, there is a lack of consensus on the appropriate treatment and management paradigms for these patients. Dr. Youn and colleagues recently published the results of a focused questionnaire assessing “how patients with CRAO are treated at academic teaching hospitals in the US including how often treatment is standardized with a formal protocol, the setting of care (emergency department versus clinic), the various treatments employed and what screening is done to evaluate for systemic disease and vascular risk factors”. 43 university hospitals of the 58 contacted responded (74% response rate). The most salient findings include: – 9% of programs opposed any acute treatments for CRAO due to lack of efficacy – 20% of programs have an established formal protocol/approach for management of acute CRAO – 35% of programs treated patients with CRAO in outpatient clinics rather than the ED – 36% of programs considered tPA (tissue plasminogen activator) as first line therapy – 53% of programs offer tPA – 67% use ocular massage at least occasionally – 89% of programs reported screening routinely for carotid artery disease There is a need for a high-quality clinical trial to assess fibrinolysis in CRAO. Ocular massage, despite lack of evidence of efficacy and possible harmful effects, is still widely used. A more thorough evaluation to decrease the risk of future cardiac and cerebrovascular events is recommended.