Abstract
Purpose :
Acute non-arteritic central retinal artery occlusion (CRAO) is a medical emergency that requires early recognition and triage, in the same manner as acute cerebral ischemic stroke. We implemented a novel process to evaluate CRAOs that equips stroke code teams with optical coherence tomography (OCT) machines and streamlines communication with retina specialists. The purpose of this abstract is to report the use of optical coherence tomography (OCT) in stroke centers for point-of-care diagnosis of CRAO and early outcomes of treatment.
Methods :
OCT machines were placed in three stroke centers throughout a 1400-bed urban tertiary health system. Patients who presented with painless monocular vision loss activated a stroke code, and macular OCT images were acquired by the stroke service. The images were transmitted electronically to the retina service with clinical data. If the diagnosis was confirmed and patients could be treated within 12 hours of last known well, they were brought directly for treatment with intra-arterial tissue plasminogen activator.
Results :
To date, 61 patients have been evaluated, 26 of whom had a confirmed retinal artery occlusion, and 11 of whom met criteria for treatment. The mean door-to-treatment time was 166 min (88-257), and the mean time-to-treatment was 8.8 hours (6.3-11.9). The mean visual acuity at presentation was logMAR 1.78 (20/1205). The mean post-treatment visual acuity was logMAR 0.89 (20/155). The mean final visual acuity 4 weeks after treatment was logMAR 0.83 (20/136). There were no severe adverse reactions.
Conclusions :
A streamlined process equipped with OCT machines and teleconsulting for point-of-care diagnosis of CRAO may improve time to treatment and thereby outcomes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.