Retinal Artery OcclusionAssociated Systemic and Ophthalmic Abnormalities

Abstract

Objective-To investigate systematically the various associated systemic and ophthalmic abnormalities in different types of retinal artery occlusion (RAO). Design-Cohort study.Participants-439 consecutive untreated patients (499 eyes) with RAO, first seen in our clinic from 1973 to 2000.Methods-At first visit, all patients had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. Initially they also had carotid Doppler/angiography and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit.Main Outcome Measures-Demographic features, associated systemic and ophthalmic abnormalities and sources of emboli in various types of RAO.Results-RAO was classified into various types of central (CRAO) and branch (BRAO) artery occlusion. In both nonarteritic CRAO and BRAO the prevalence of diabetes mellitus, arterial hypertension, ischemic heart disease, and cerebrovascular accidents were significantly higher compared to the prevalence of these conditions in the matched US population (all p<0.0001). Smoking prevalence, compared to the US population, was significantly higher for males (p=0.001) with nonarteritic CRAO and for females with BRAO (p=0.02). Ipsilateral internal carotid artery had ≥50% stenosis in 31% of nonarteritic CRAO patients and 30% of BRAO, and plaques in 71% of nonarteritic CRAO and 66% of BRAO. Abnormal echocardiogram with embolic source was seen in 52% of nonarteritic CRAO and 42% of BRAO. Neovascular glaucoma developed in only 2.5% of nonarteritic CRAO eyes.Conclusion-This study showed that in CRAO as well as BRAO the prevalence of various cardiovascular diseases and smoking was significantly higher compared to the prevalence of these conditions in the matched US population. Embolism is the most common cause of CRAO and BRAO;Correspondence to: Dr. S.S. Hayreh, Department of Ophthalmology and Visual Sciences, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091, Telephone No. 319-356-2947 sohan-hayreh@uiowa.edu. The authors have no conflict of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2010 October 1. Published in final edited form as:Ophthalmology . 2009 October ; 116(10): 1928-1936. doi:10.1016/j.ophtha.2009.006. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript plaque in the carotid artery is usually the source o...

A review of central retinal artery occlusion: clinical presentation and management

“…64 Hayreh et al 20 showed no cause-effect relationship between CRAO and ocular neovascularization in their cohort of 232 patients with CRAO. 20 On the other hand, Rudkin et al 64 showed a temporal relationship between the CRAO and neovascularization events, and the patients who developed neovascularization did not have other clinical features, such as diabetes or an association with a haemodynamically significant stenosis of the carotid artery to account for the neovascularization other than CRAO. As such, there is no consensus on the best followup regimen after CRAO to detect the ocular neovascular complications and optimally manage CRAO.…”

“…A recent aged-matched cohort study, including 249 patients (289 eyes) with CRAO, confirms these associations with the addition of renal disease. 20 Other risk factors are a family history of any type of vascular disease. In younger patients (under 50 years), proatherogenic states, such as hyperhomocystenemia, factor V Leiden, protein C and S and anti-thrombin deficiencies, anti-phospholipid antibodies or prothrombin gene mutations, sickle cell disease, and migraine due to vasospasm and paraneoplastic syndromes may all contribute to non-arteritic CRAO.…”

How does hypertension affect your eyes?

“…Microemboli may be derived from non-hemodynamically significant obstruction, due to only a small intraluminal plaque(s), most commonly from carotid arteries (66%), which may be present even in absence of significant stenosis of carotid artery. 84 Arterial hypertension, diabetes mellitus, hyperlipidemia, carotid artery disease, coronary artery disease, transient ischemic attack and tobacco smoking are the common risk factors for retinal arterial occlusions, with systemic hypertension showing a significant association in more than 50% of these patients. 84 Echocardiographic abnormalities have been documented in patients with RAO with 10% needing systemic management.…”

“…84 Arterial hypertension, diabetes mellitus, hyperlipidemia, carotid artery disease, coronary artery disease, transient ischemic attack and tobacco smoking are the common risk factors for retinal arterial occlusions, with systemic hypertension showing a significant association in more than 50% of these patients. 84 Echocardiographic abnormalities have been documented in patients with RAO with 10% needing systemic management. 81 RAO has also been reported to be associated with an increase risk of cardiovascular disease, stroke and mortality.…”

“…In the heart, sources of emboli are valvular lesions and tumors. 84,95 Retinal emboli are usually asymptomatic and detected incidentally during eye examinations. 96 Because most retinal emboli are transient, their prevalence is likely to have been underestimated in most epidemiological studies.…”