Appropriately Managing Acute Retinal Strokes in the Emergency Eye Room – A Multi–centred UK Study

Abstract

Abstract: : Purpose: Following non–arteritic retinal artery occlusions and amaurosis fugax patients are at high risk of early recurrent vascular events and require urgent investigation and treatment of risk factors, beginning in the emergency eye room. There are no published data on the care received by patients presenting to emergency eye departments. Methods: The medical records of a consecutive series of 163 patients with acute retinal arterial ischemic events were reviewed in four UK eye centres. New areas of relevant evidence were also identified from the stroke and medical retina literature. Results: 120 patients with central and branch retinal artery occlusions and 43 with amaurosis fugax were reviewed. Management varied considerably across eye centres. Carotid–imaging ranged from 35% to 70% (p=0.002), 9% to 71% received antiplatelet agents (p<0.001), 31% were not started on antiplatelet treatment and less than a third received statin therapy. Documentation of blood pressure ranged from 32% to 99% (heterogeneity: p<0.001) and sub–specialty referral and follow–up method varied considerably. An evidence–based algorithm was developed and is presented, incorporating recent data from the stroke and retina literature for managing patients in the Emergency Eye Room. Conclusions: Significant differences in practice between emergency eye centres are demonstrated. Management of these high–risk patients presenting to eye departments is sub–optimal, highlighting the need for guidelines for Ophthalmologists such as presented.

Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled • neuro-ophthalmology: diagnosis • retina