Abstract
Purpose :
The American Academy of Ophthalmology Preferred Practice Patterns guidelines recommend immediate referral for stroke workup, including diagnostic imaging, after RAO. Previous case series and studies from emergency department data suggest many patients do not receive appropriate diagnostic imaging. This study aims to characterize the frequency and patterns of stroke workup after RAO.
Methods :
Retrospective claims-based analysis of adults ≥18 years of age in IBM® MarketScan®, a nationally representative sample of commercial insurance beneficiaries with central or branch retinal artery occlusion (CRAO/BRAO) from 2007-2016. We excluded patients with a prior stroke diagnosis, retinal vein occlusion diagnosis within one month of index CRAO or BRAO diagnosis, and prior giant cell arteritis or polyarteritis nodosa diagnosis. The primary study outcome was any stroke imaging, including head imaging, carotid imaging, and echocardiography identified by International Classification of Disease, Ninth and Tenth Revision (ICD-9/ICD-10) codes.
Results :
Between 2007 to 2016, 47253 patients were diagnosed with CRAO (15859, 33.5%) or BRAO(31394, 66.5%). Mean age was 66.9 ± 14.1 years, 24682 (52.2%) were male, and mean enrollment length was 4.8 ± 2.5 years. Of patients with RAO, 24197 (50.9%) received any imaging for workup of ischemic stroke, of which 8011 (16.6%) underwent head imaging, 19041 (40.0%) underwent carotid imaging, 12855 (27.1%) underwent echocardiography. Adults <50 years had lower rates of any imaging (40.1% vs. 52.2% p<0.001), echocardiography (22.2% vs. 27.6% p<0.001), and carotid imaging (21.8% vs. 41.4% p<0.001), compared to adults ≥50 years. Age was not associated with a difference in the rate of head imaging (16.8% vs. 16.9%, p=0.89). Patients with a CRAO were more likely to undergo any imaging (53.6% vs 49.5%, p < 0.001). Multiple logistic regression indicated that older age (OR 1.01 95% CI, [1.01-1.02], p < 0.001), male sex (OR 1.21, 95% CI [1.16-1.25], p < 0.001), and CRAO diagnosis (OR 1.15, 95% CI [1.11-1.20], p < 0.001) were independent predictors for undergoing any imaging. The frequency of stroke workup increased over the study period (r^2 = 0.77, p = 0.0003, Figure 1).
Conclusions :
Approximately 1 in 2 patients received diagnostic imaging for stroke workup after RAO. Male sex, older age, and CRAO diagnosis were associated with an increased frequency of stroke workup.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.