American Heart Association Releases Scientific Statement on Central Retinal Artery Occlusion, Calling it Eye Stroke
The American Heart Association and American Stroke Association have released a new scientific statement in Stroke, regarding central retinal artery occlusion (CRAO) as a form of ischemic stroke. The statement reviews the evidence that CRAO is also a warning of future brain strokes that needs immediate medical treatment to reduce damage and possibly prevent future strokes. CRAO typically causes painless, immediate vision loss in the impacted eye, with fewer than 20% of people regaining functional vision in the eye.
Most concerning is the fact that many practitioners may not recognize CRAO as a form of stroke, resulting in delayed testing and treatment.
“We know acute CRAO is a medical emergency requiring early recognition and triage to emergency medical treatment,” said Brian C. MacGrory, MBBH, BAO, MRCP, assistant professor of neurology and staff neurologist, Duke Comprehensive Stroke Center, Duke University School of Medicine. “There is a narrow time window for effective treatment of CRAO and a high rate of serious related illness. So, if a person is diagnosed in a doctor’s office or other outpatient clinic, they should be immediately sent to a hospital emergency department for further evaluation and treatment. CRAO is a cardiovascular problem disguised as an eye problem. It is less common than stroke affecting the brain, but is a critical sign of ill health and requires immediate medical attention. Unfortunately, a CRAO is a warning sign of other vascular issues, so ongoing follow-up is critical to prevent a future stroke or heart attack.”
Noting that there is very little literature and awareness of CRAO as a form of stroke, a panel of researchers from neurology, ophthalmology, cardiology, interventional neuroradiology, neurosurgery, and vitreoretinal surgery reviewed and summarized the existing science for this condition.They found CRAO is associated with carotid artery disease and atrial fibrillation, and that the risk of having a CRAO increases with age and cardiovascular risk factors (eg, hypertension, hyperlipidemia, Type 2 diabetes, smoking, and obesity).
Current literature suggests that treatment with intravenous tissue plasminogen activator (tPA) may be effective if administered within 4.5 hours of the first sign of symptoms. Emerging treatments, such as hyperbaric oxygen and intra-arterial alteplase, novel thrombolytics, and neuroprotective agents show promise but require further study. There are and clinical trials for treatment of CRAO are needed.
Because of the potential for future strokes or heart attacks, anyone who experienced CRAO should undergo urgent screening and treatment of vascular risk factors. Secondary prevention, including monitoring for complications, must be a collaborative effort between neurologists, ophthalmologists, cardiologists, and primary care clinicians.