Authors’ reply

Abstract

We appreciate the thoughtful comments of Dr. Olsen and colleagues on our article “Central retinal artery occlusion–a new, provisional treatment approach”. 1 Chronopoulos A. Schutz J.S. Central retinal artery occlusion-A new, provisional treatment approach. Surv Ophthalmol. 2019; 64: 443-451 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar We agree that central retinal artery occlusion (CRAO) is a stroke, and we emphasize this in our article because we believe it is still not well understood, nor its significance, by many ophthalmologists, emergency physicians, neurologists, and generalists. We also agree that there is no strong evidence-based therapy for CRAO; however, despite the recommendation of no ophthalmic treatment by the Preferred Practice Pattern covering CRAO, 5 Olsen T.W. Pulido J.S. Folk J.C. et al. Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern(R). Ophthalmology. 2016; 124: P120-P143 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar ophthalmologists worldwide continue to perform various therapies for CRAO. 2 Kim S.H. Cha Y.S. Lee Y. et al. Successful treatment of central retinal artery occlusion using hyperbaric oxygen therapy. Clin Exp Emerg Med. 2018; 5: 278-281 Crossref PubMed Scopus (12) Google Scholar , 3 Kim H.M. Park Y.J. Park K.H. Woo S.J. Visual field defects and changes in central retinal artery occlusion. PLoS One. 2019; 14: e0209118 PubMed Google Scholar , 6 Park H. Nakagawa I. Yokoyama S. et al. Central Retinal Artery Thromboembolism without Ophthalmic Artery Occlusion During Stent-Assisted Coil Embolization of Ophthalmic Artery Aneurysm. World Neurosurg. 2019; 121: 77-82 Crossref PubMed Scopus (6) Google Scholar , 7 Wang X. Sun B. Wang J. et al. Quantitative evaluation of retinal artery occlusion using optical coherence tomography angiography: A case report. Medicine (Baltimore). 2018; 97: e12652 Crossref PubMed Scopus (2) Google Scholar , 8 Youn T.S. Lavin P. Patrylo M. et al. Current treatment of central retinal artery occlusion: a national survey. J Neurol. 2017; 265: 330-335 Crossref PubMed Scopus (51) Google Scholar Even the 2018-2019 American Academy of Ophthalmology Basic and Clinical Science Course Retina and Vitreous does not advocate no ophthalmic treatment for CRAO but states for management of CARO, “Simple therapeutic approaches, such as reducing IOP by administering IOP-lowering medications and performing ocular massage, are not without benefit. However, outcomes from both anterior chamber paracentesis and carbogen (a mixture of 95% oxygen and 5% carbon dioxide) vasodilatory inhalation therapy have shown inconsistent success, as have hyperbaric oxygen therapy, catherization of the ophthalmic artery with tissue plasminogen activator infusion, and transvitreal ND:YAG embolysis. Initial management should also include an evaluation directed toward determining the underlying systemic etiologic factors.” 4 McCannel C. Retina and Vitreous, Basic and Clinical Science Course, in Ophthalmology AAo. American Academy of Ophthalmology, San Francisco, CA2018-2019: 146 Google Scholar Comments on: Central retinal artery occlusions–A new, provisional treatment approachSurvey of OphthalmologyVol. 65Issue 1PreviewWe read with great interest, the article by Chronopoulos and Schutz entitled Central retinal artery occlusions–A new, provisional treatment approach.4 We also acknowledge the comments by Grzybowski and Kanclerz5 regarding the lack of evidence basis for the recommendation for a paracentesis in the setting of a recent retinal artery occlusion (RAO). We believe that further clarification is in order regarding the management of RAO. Full-Text PDF