By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Panel: Timothy W. Olsen, MD,1 Jose S. Pulido, MD, MS, MPH,2 James C. Folk, MD,3 Leslie Hyman, PhD,4 Christina J. Flaxel, MD,5 Ron A. Adelman, MD, MPH, MBA, FACS,6
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1 Emory Eye Center, Emory University, Atlanta, Georgia
2 Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
3 Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, Iowa
4 Division of Epidemiology, Department of Family, Population and Preventive Medicine, School of Medicine, Stony Brook University, Stony Brook, New York
5 Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
6 Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
An ophthalmic artery occlusion (OAO) or retinal artery occlusion (RAO), central retinal artery occlusion (CRAO), or, less commonly, a branch retinal artery occlusion (BRAO) in patients over 50 years of age should raise immediate clinical suspicion for giant cell arteritis (GCA) or other life-threatening conditions (e.g., carotid occlusive or cardiac valve disease). The clinician should evaluate appropriately and consider the role of urgent systemic corticosteroid therapy in an attempt to preserve or recover vision in the affected eye.4,5 (I-/I+, good quality, strong recommendation
An OAO or RAO patient of any age should have a systemic evaluation for vascular occlusive disease; generally, a vasculitis or hypercoagulable workup in younger patients6 and an embolic workup in older patients. (III, good quality, strong recommendation)
Acute, symptomatic OAO or CRAO from embolic etiologies should prompt an immediate referral to the nearest stroke referral center for prompt assessment for consideration of an acute intervention. However, the current evidence is limited for a similar referral for patients with an asymptomatic BRAO. (III, good quality, strong recommendation)
In general, there are no proven therapies or treatments for the ocular manifestations of CRAO, BRAO, or OAO. Nevertheless, posterior segment arterial occlusions require prompt evaluation and management. These occlusions may be an important clinical indicator of a more severe systemic disorder or of an embolic, inflammatory, infectious, or other process. As such, they may require the clinician or the patient’s medical doctor to initiate a systemic medical evaluation that is urgent and targeted to the patient.
In vascular occlusive disorders of the eye, there is an increased risk for posterior and/or anterior segment neovascularization. The schedule for follow-up visits should consider the extent of retinal or ocular ischemia. Specifically, patients with greater ischemia require more frequent follow-up.