Central retinal artery occlusion: timing and mode of presentation

Abstract

Central retinal artery occlusion (CRAO) is a sudden, frequently irreversible, monocular vision loss, analogous to acute cerebral ischaemia. Thrombolysis may improve visual outcomes, but it is unclear what the acceptable timing of administration should be. We aim to ascertain, through audit, the timing and mode of presentation of individuals with potentially thrombolysable CRAOs. A retrospective audit of patients with acute thromboembolic CRAO. Thirty-one patients were identified. Mean time from onset of vision loss to presentation was 31 +/- 65 h. Eighteen patients (58%) presented within 20 h of vision loss, and the majority presented first to a general practitioner. Fifteen patients (48%) were reviewed by an in-hospital ophthalmologist within 20 h of vision loss. The mean delay from the referring source to assessment by an in-hospital ophthalmologist was 5.2 h (median 3.3 h, range 50 min to 24 h). This delay was, on average, shorter for patients referred directly to an ophthalmology clinic. Just under half (48%) of our cohort of CRAO patients were reviewed by an in-hospital ophthalmologist within the 20-h therapeutic time window for thrombolytic therapy and thus could qualify for inclusion in a randomized controlled trial according to EAGLE inclusion criteria. If thrombolysis is proven to be a feasible and safe treatment in CRAO then public awareness should be raised of the symptoms and an efficient direct referral pathway to an in-hospital ophthalmologist established to aid treatment delivery.