Abstract
Purpose :
To assess the accuracy of Retinal Artery Occlusion (RAO) diagnoses and quantify the conditions mistaken for an RAO.
Methods :
This is a retrospective single institution chart review of patients with an initial diagnosis of an RAO as determined by the presence of “Retinal Artery Occlusion” or “RAO” in the clinical note or an associated International Classification of Disease, Tenth Revision coded diagnosis between 2010 and 2020. Patient demographic and diagnostic information were identified and analyzed. Definitive diagnoses were classified as those where “Retinal Artery Occlusion” appeared at the top of a differential diagnosis for at least three clinical visits or was the sole diagnosis during at least one clinical visit. Revised diagnoses were grouped into pathophysiological categories.
Results :
A total of 2,198 patients were identified with an RAO diagnosis. 1,475 patients were excluded due to incomplete records or incorrect acquisition. 728 patients were identified with a supported RAO diagnosis. 128 of 723 (18%) RAO diagnosis patients were identified as misdiagnoses (mean age of 62; 45% male and 55% female). 40 (37%) misdiagnosed patients initially presented to the emergency department. 99 (77%) misdiagnosed patients presented within 31 days of the onset of visual symptoms (mean delay of symptom onset to clinical presentation of five days). The most common pathophysiologies of misdiagnosis were Anterior Ischemic Optic Neuropathy (30%), Retinal Venous Occlusion (20%), and Retinal Detachment/Edema/Hemorrhage (13%). Of documented eye exams, 55 OD (48%) and 57 OS (51%) presented with a Snellen visual acuity of less than 20/40 vision, 12 patients (11%) presented with elevated intraocular pressure, and 33 patients (35%) with a relative afferent pupillary defect. Of the misdiagnoses, 36 (28%) were made by non-ophthalmologist physicians, 76 (59%) by ophthalmologists, and 16 (13%) by optometrists.
Conclusions :
18% of patients who presented with a diagnosis of RAO did not have evidence of an RAO upon further evaluation. This high rate of misdiagnosis can cause substantial delays in patients receiving appropriate treatment, negatively impacting visual outcomes. Greater emphasis on a thorough ophthalmic exam may elucidate findings highly demonstrative of another pathology. These findings support a careful clinical assessment of RAOs before initiating an extensive intervention.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.