Patients experiencing vision loss from central retinal artery occlusion (CRAO) delay seeking medical attention for more than a day on average, according to a retrospective cohort study published in Ophthalmology Retina. Receiving appropriate treatment sooner may potentially improve patient outcomes, the report suggests.
“Given the benefit to visual outcome has only shown statistical significance with administration in under 4.5 hours, to justify risk of intravenous thrombolysis, patients should ideally present and be treated within that time frame,” according to the study authors.
Researchers performed a retroscopic chart review of 484 patients (mean age, 73.1 years; 54% men) diagnosed with CRAO between 2011 and 2020. The team examined patient demographics, time from symptom onset to presentation, and presentation characteristics.
The cohort demonstrated considerable variability in presenting for care, with 60.3% accessing care at an emergency department, 27.5% seeking treatment with an ophthalmologist, and 6.8% presenting to an optometrist. The average time from symptom onset to presentation was 25.7 hours and patients were not treated by an ophthalmologist until a mean 49.0 hours following symptom onset. A total of 51% of participants sought medical attention within a 4.5 hour time frame, and 32.8% accessed an ophthalmologist within that time period.
Stratified according to ethnicity, patients who were Black delayed presenting for treatment the longest (mean, 41.3 hours), followed by individuals who were Hispanic (mean, 39.7 hours), White (mean, 23.9 hours), and Asian (mean, 19.7 hours). Ethnicity, however, was not a significant predictor for the delay in presentation from symptom onset (P =.32).
“To improve the likelihood of patients with CRAO being diagnosed within a therapeutic window for intravenous thrombolysis, educational efforts must underscore to patients and medical providers that acute, painless monocular vision loss may signify an ischemic stroke,” according to the researchers. “Educational campaigns have been shown to reduce presentation times for cerebral stroke. Changes in healthcare delivery systems are also needed to hasten the time from patient presentation to diagnosis.”
Study limitations include a retrospective nature and the use of unstructured documentation for determining the time of presentation.
Shah R, Gilbert A, Melles R, et al. Central retinal artery occlusion: time to presentation and diagnosis. Ophthalmol Retina. Published online January 10, 2023. doi:10.1016/j.oret.2023.01.005