• CRAO-Associated Vascular Ischemic Events on the Rise

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD

    Journal Highlights

    American Journal of Ophthalmology, April 2019

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    Central retinal artery occlusion (CRAO) confers a high risk of acute vascular ischemic events, including myocardial infarction (MI) and stroke. Under­standing the burden and risk-factor profile of ischemic events can help ophthalmologists in managing and referring patients. Mir et al. performed a nationwide cross-sectional study to determine the incidence and predictors of in-hospital ischemic events among inpatients with a diagnosis of CRAO in the United States. They found that the incidence of stroke nearly doubled from 2003 to 2014. They also identified the following pre­dictive factors: female sex, hypertension, carotid artery stenosis, aortic valve disease, smoking, and alcohol depen­dence/abuse.

    During the 12-year study period, the estimated number of CRAO inpatient admis­sions was 17,117. The mean age was 68.4 years, and 53% were female. The overall in­cidence of in-hospital stroke and acute MI was 12.9% and 3.7%, respectively. The incidence of stroke increased significantly over time, from 7.7% in 2003 to 15.3% in 2014. Among this CRAO population, the combined risk of stroke, transient isch­emic attack, and acute MI (or mortality) was 19%.

    This research shows that the burden of vascular risk in this patient population is sizable and growing. At present, there are no options to significantly improve visual outcomes in patients with CRAO; therefore, clinical management involves prevent­ing vascular ischemic events. Because stroke risk is highest at the time of occlusion, prompt clinical evaluation is warranted, along with timely execution of stroke prevention measures.

    To the authors’ knowledge, their study is the largest of its kind to date. The findings confirm that CRAO is an important marker for subsequent vas­cular ischemic events. As the incidence of CRAO-associated stroke continues to rise, it would be prudent to have an adjunctive risk-prediction model to assist in triaging and referral, the authors said. This would optimize early evaluation of patients with the highest risk for ischemic events.

    The original article can be found here.