• Ocular Arterial Occlusive Disorders and Carotid Artery Disease

    By Peggy Denny and selected by Andrew P. Schachat, MD

    Journal Highlights

    Ophthalmology Retina, January 2017

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    Hayreh and Zimmerman
    carried out a large cohort study to compare the prevalence of carotid artery disease (CAD) and its various manifestations in patients with specific types of ocular arterial occlusive disorders. They found that the incidence of carotid artery stenosis and plaques, cardiac embolic source, transient ischemic attack (TIA)/stroke, and myocardial ischemia (MI) differ among various ocular arterial occlusive disorders.

    The study included 614 patients (728 eyes) with an ocular arterial occlu­sive disorder: nonarteritic anterior isch­emic optic neuropathy (NAION; 266 eyes), central retinal artery occlusion (CRAO; 203 eyes), branch retinal artery occlusion (BRAO; 127 eyes), ocular ischemic syndrome (OIS; 80 eyes), and amaurosis fugax (AF; 52 eyes). All patients also had CAD. At first visit, patients had a detailed ophthalmic and medical history, ophthalmic evaluation, carotid artery evaluation (by Doppler/angiography) on the side of ocular arte­rial occlusion, and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit.

    The authors found that carotid artery stenosis on the involved side was worse in AF and OIS compared with BRAO, CRAO, and NAION; whereas the presence of carotid artery plaques on the involved side was significantly higher in OIS, AF, and CRAO com­pared with NAION. Echocardiography revealed an embolic source in 61% of CRAO and 53% of BRAO patients compared with only 3% of NAION patients. TIA/stroke occurred before or after onset of the ocular condition in 17% of OIS, 11% of AF, 7% of CRAO, 6% of NAION, and 3% of BRAO pa­tients. Kaplan-Meier estimate of the in­cidence of TIA/stroke within 3 months after onset was 6% (95% CI, 2%-17%) for OIS, 3% (95% CI, 0.4%-19%) for AF, and 1% (95% CI, 0.3%-4.1%) for CRAO. Report of MI before or after onset of ocular condition was 52% in AF, 22% in OIS, 22% in BRAO, 21% in CRAO, and 6% in NAION patients.

    The authors concluded that the incidence of carotid artery stenosis and plaques, cardiac embolic source, TIA/stroke, and MI differ among various ocular arterial occlusive disorders. Further, they noted that embolism and hemodynamic disturbances are inde­pendently associated with these ocular disorders.

    The original article can be found here.

    Introducing Ophthalmology Retina

    EyeNet now features summaries from the Academy’s Ophthalmology Retina, a new peer-reviewed journal focused exclusively on retina-related eye diseases and conditions. During 2017, Ophthalmology Retina will be issued bimonthly.