Abstract WMP56: Diagnosis of Acute Central Retinal Artery Occlusion With a Nonmydriatic Ocular Fundus Camera Combined With Optical Coherence Tomography in the Emergency Department: A New Paradigm

Abstract

Background: Central retinal artery occlusion (CRAO) is a retinal infarction with causes/management similar to cerebral infarction. However, CRAO diagnosis is often delayed, resulting in missed opportunities for rapid treatment. Diagnosis by ophthalmologists is essential prior to management by stroke neurologists and may be challenging within a few hours of vision loss. Our goal is to provide a new paradigm in the emergency department (ED) with the implementation of a nonmydriatic ocular fundus camera (NMFP) combined with optical coherence tomography (OCT) to allow for ultrarapid remote diagnosis and stroke alert as soon as patients present to the ED. Methods: Prospective collection of data from consecutive patients who had NMFP-OCT for acute monocular vision loss in our general ED affiliated with a comprehensive stroke center. We collected timing of photographs; final diagnosis (CRAO/other causes of vision loss); time between vision loss onset and CRAO diagnosis; NMFP-OCT findings. Results: Over 9 weeks, 27 patients had NMFP-OCT obtained for acute monocular visual loss, including 9 CRAO [others included 7 retinal detachments; 8 vitreous hemorrhages; 3 temporal arteritis]. Diagnosis of acute CRAO was made remotely on NMFP-OCT obtained 30, 33, 36 min after arriving in ED in 3 patients presenting to ED within 3.5 hrs of vision loss. In all 3 patients, the ocular color photographs were almost normal and acute CRAO diagnosis was made primarily from the OCT showing inner retinal edema/hyperreflectivity. Conclusion: Incorporating NMFP-OCT into the ED workflow can be used as a substitute for funduscopic examination/pupillary dilation, allowing for remote diagnosis of CRAO by ophthalmologists who can provide real time recommendations before in person visit. These positive preliminary results suggest that this strategy accelerates the diagnosis of urgent vision loss, resulting in improved patient outcomes. Results of the first 6 months will be presented at the conference.