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J. Penzner, M. Silverberg, P. Cisek; Clinical Utility of Carotid Ultrasonography in General Ophthalmologic Practice . Invest. Ophthalmol. Vis. Sci. 2006;47(13):942.
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Possible predictors of carotid artery occlusive disease include Hollenhorst plaques, asymmetric retinal hemorrhages, amaurosis fugax, and transient visual obscurations. While these are accepted as common indicators for carotid ultrasonography, the value of this test is uncertain. The purpose of this study was to evaluate the clinical utility of carotid ultrasound in the general ophthalmology practice.
A three–year retrospective review was performed of all patients who underwent carotid ultrasound testing. The indication for ultrasound, percent carotid stenosis, and need for carotid endarterectomy were analyzed. Other outcome measures, such as stroke and death were recorded. Pertinent historical factors for vasculopathy such as hyperlipidemia, diabetes, coronary artery disease, renal insufficiency, and hypertension were also noted.
Computerized records showed sixty–three patients who underwent carotid ultrasound tests. The mean age was 68.4 years. Fifty–three (84%) of sixty–three had at least one vasculopathic risk factor. Indicators for ultrasonography included: Transient visual obscuration (29/63, 46%), amaurosis fugax (4/63, 6.4%), Hollenhorst plaque (20/63, 31.8%), asymmetric retinal hemorrhages (4/63, 6.4%), and stroke (2/63, 3.2%). Other indicators were ischemic optic neuropathy (1/63, 1.6%), cranial nerve palsy (1/62, 1.6%) and unexplained visual field deficit (1/63, 1.6%). Three (4.8%) of sixty–three patients had stenosis >40% of the internal carotid system. Of these three, two had the ultrasound because of a transient visual obscuration; the third had a Hollenhorst plaque. All three were hypertensive and had coronary artery disease, while two were additionally diabetic and hyperlipidemic. No patient underwent subsequent carotid endarterectomy. One of sixty–three (1.6%) died. Two of sixty–three (3.2%) had stroke.
Based on commonly accepted indications from a general ophthalmology practice, there was a low clinical yield with regard to detecting significant carotid stenosis and need for endarterectomy. In this context, the utility of carotid ultrasonography is equivocal.
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