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Drew Scoles, Peiying Hua, Brendan McGeehan, Brian L VanderBeek; Recent practice patterns in acute retinal artery occlusions in the United States. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1929.
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To determine how practice patterns for work-up of acute retinal artery occlusion (RAO) compare to recent guidelines published by the American Academy of Ophthalmology (AAO).
Patients receiving new diagnosis of either central (CRAO) or branch (BRAO) retinal artery occlusion were identified from a large national US medical claims database between 2004 and 2016. Claims were reviewed for key diagnostic tests specified by the AAO as recommended components of an RAO work-up including carotid ultrasound, echocardiogram, magnetic resonance imaging (MRI) and emergency room referral. The RAO diagnosing provider was categorized as an ophthalmologist, neurologist or other. Patients were excluded for prior history of RAO or occurrence of specified testing listed above in the 6 months preceding their diagnosis.
9300 new outpatient diagnoses of RAO (5818 BRAO, 3482 CRAO) were analyzed. 14.8% of patients received carotid ultrasound within 7 days, and 27.8% within 30 days post diagnosis. Patients with CRAO (vs. BRAO), male gender, younger age, white race and upper Midwest location were significantly most likely to receive a carotid ultrasound within 7 days. 7.6% of patients received echocardiogram screening within 7 days and 18.4% within 30 days. Patients with CRAO, male gender, younger age, white race and upper Midwest location were significantly most likely to receive an echocardiogram within 7 days. 2.8% of patients received a brain MRI screening within 7 days and 5.7% within 30 days. Patients with CRAO and upper Midwest location were most likely to receive MRI within 7 days. 1.7% of patients were referred to the ED on the day or day after diagnosis. Younger age was associated with significantly increased likelihood of ED referral. Ophthalmologists diagnosed the majority (88.1%) of RAOs compared to neurologists (0.3%) and other (11.5%). Compared with “other” doctors, patients diagnosed by ophthalmologists were significantly more likely to have carotid ultrasound within 7 days, but less likely to have echocardiogram, MRI or emergency room referral (p<0.001 for all comparisons). The rates for each of the AAO care guidelines increased significantly between 2004 and 2016 (p<0.01).
The management of acute RAO in this contemporary patient cohort falls considerably short of the recent AAO recommendations.
This is a 2020 ARVO Annual Meeting abstract.
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