Abstract
Acute central retinal artery occlusion (CRAO) induces a time-dependent increase in retinal thickness. By manually measuring the relative retinal thickness increase (RRTI) in comparison to the contralateral eye based on optical coherence tomography (OCT), ischemia onset within the past 4.5 hours could be determined with 100% sensitivity and 94.3% specificity. To enable examiner-independent and quicker diagnostics, we analyzed the RRTI using the automatic retinal thickness measurement. In this retrospective study, 28 eyes were evaluated with an acute CRAO (<46 hours). All patients received a Spectralis SD-OCT image of both eyes. The RRTI was calculated for the ETDRS sectors using the Segmentation Module for Single Retinal Layer Analysis. Receiver operating characteristic (ROC) analysis was performed to determine patients ≤4.5 hours by RRTI. In all sectors, time to OCT (TTO) and RRTI correlated positively. The optimal cutoff point to detect CRAOs ≤4.5 hours was between 18.7% nasally and 22.9% RRTI temporally. Sensitivity and specificity varied between the sectors with 90–95% sensitivity and 89–100% specificity. In conclusion, the automatic measurement of RRTI also allows the differentiation of CRAOs within a possible therapeutic time window ≤4.5 hours and CRAOs ≥4.5 hours with a high sensitivity and specificity. Additionally, it offers quicker, easier, and a user-independent assessment of ischemia onset, helping to set a base for establishing automatic indices generated by the OCT machines.
Highlights
Acute central retinal artery occlusion (CRAO) is an ophthalmic emergency causing massive monocular vision loss
An evidence-based therapy does not exist, but recent case series and meta-analyses show that intravenous fibrinolysis administered within 4.5 hours could enhance the prognosis of CRAO patients [1,2,3]
In a previous study [5], we have shown that, in CRAO patients, ischemia onset ≤4.5 hours can be determined by Journal of Ophthalmology manual measurement with a sensitivity of 100% and a specificity of 94.3%. is manual analysis of optical coherence tomography (OCT) scans is based on the relative retinal thickness increase (RRTI) in comparison to the fellow eye
Summary
Acute central retinal artery occlusion (CRAO) is an ophthalmic emergency causing massive monocular vision loss. An evidence-based therapy does not exist, but recent case series and meta-analyses show that intravenous fibrinolysis administered within 4.5 hours could enhance the prognosis of CRAO patients [1,2,3]. Determining the onset of CRAO is sometimes difficult. If monocular sudden vision loss is recognized with both eyes open, the patients can exactly determine the time of symptom onset. Other patients recognize the vision loss by accidentally closing the unaffected eye and report a wrong time of symptom onset. If the onset of ischemia is unsure, patients will not qualify for treatment options as risks outweigh benefits. Determining the onset of ischemia is crucial to introduce patients to therapeutic options
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