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Tina B. Khanam, Gillian Vafidis; What Is The Yield Of Identifying Previously Unknown Risk Factors In Rvo Patients?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3605.
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© ARVO (1962-2015); The Authors (2016-present)
The current guidelines aim to guide Ophthalmologists in the management of RVO. The investigations of RVO stem from long established practices, which are largely unchallenged, despite the dynamic nature of medicine. We question whether such extensive battery of expensive tests is necessary for the investigation of RVO and what the yield of identifying patients with previously unknown modifiable and important risk factors is.
This is a retrospective study of 50 eyes (48 patients) diagnosed with RVO in one hospital in the last 4 years. Data collection was from electronic copies and hard copies of patient notes, as well as electronic resources of patient blood results. Data collected are patient demography, date of diagnosis, side affected, classification, risk factors. With regards to investigations, we noted whether routine or advanced tests were requested and by whom. Results of patients’ investigations were analysed and patients stratified into three risk groups, patients with known risk factors, patients without previous known risk factors and young patients with risk factors (less than 50 years).
The age range was 49-90. The percentage of male is 56% and female is 44%. Ethnicity data revealed, 55% Caucasian, 9% Afro-Caribbean, 36% Asian. Side affected, left 46% and right 54%. The classification data revealed CRVO 20%, hemi-field 10% and BRVO 70%. Previously unknown LVH on ECG was found in 0%. Risk factors data revealed, 30% had hypertension, 60% had hyperlipidaemia, 40% had diabetes, 6% had glaucoma, 80% had atherosclerotic conditions, and 0% had thrombophilia. Data for other rare risk factors are 0% with myeloproliferative disorders, 30% chronic renal failure, 0% hypothyroidism, 0% Behcets disease, 0% polyarteritis nodosa, 0% Sarcoidosis, 0% Wegner’s and 0% Goodpasture’s syndrome. Of all patients, 2% had new risk factors identified. 25% tests were organised by Ophthalmologists, 65% by GP and 10% other specialists. Of all patients 98% had previously known risk factors, 2% had no previous risk factors and 8% were young.
The yield of identifying patients with previously unknown risk factors is low (2%). We conclude performing all the recommended tests on all patients is not cost effective and propose a better risk stratification.
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