Title : Exploring retinal artery occlusion pathways to care: Could thrombolysis be implemented with current pathways?
Abstract:
Introduction: Central retinal artery occlusion (CRAO) or ocular stroke, has an incidence between 1-10 per 100,000, causing sudden and painless vision loss. Following CRAO there is an increased risk of cerebral stroke, rendering it a potential sight and life-threatening event. Intravenous thrombolysis has been shown to increase visual recovery rates if given within 4.5 hours of onset, compared to standard therapy and natural history. Therefore, direct therapy and provision of secondary prevention are time critical. The American Heart Association in 2021 recommended “systems of care should evolve to prioritise early recognition and triage of CRAO”. This study aimed to evaluate the time taken from onset to arrival, time to diagnosis and treatment, with the overall aim to judge whether thrombolysis is viable with current pathways.
Methods: This single-centre retrospective records review identified 41 individuals referred to TIA clinic with a diagnosis of retinal artery occlusion between February 2024 and February 2025. 19 cases were excluded due to insufficient data regarding the onset of symptoms, incidental finding diagnosis or re-referral from a prior diagnosis. Data was extracted from electronic medical records of 22 individuals with a diagnosis of CRAO or branch retinal artery occlusion (BRAO), including: time from onset to arrival, referrals made, contact points, time between contact points and diagnosis and visual acuity outcome.
Results: Only 13.6% of the 22 individuals in this study presented to hospital within the 4.5-hour timeframe for thrombolysis. The median time from onset to first healthcare contact point was 2.2 days. 86.4% met with two different healthcare providers with no urgent referral to the stroke team. 36.4% sought help from a location where thrombolysis is currently administered. The most common initial presentation locations were high-street opticians, optometrists or the emergency department. The primary delay was public lack of recognition of the severity of symptoms and seeking help too late.
Conclusion: This study identified inefficiencies in current referral pathways and public education, preventing timely intervention essential for the implementation of thrombolysis. The study results support findings from other studies which found thrombolysis rates for CRAO are much lower compared to cerebral stroke. Improvements including enhanced rapid referral protocols and campaigns to educate the public on CRAO/BRAO are the key to reducing avoidable, life changing vision loss and stroke prevention.
