Workup following retinal artery occlusion—experience from an outpatient retina clinic and the delay in workup

Referral Patterns of Central Retinal Artery Occlusion to an Academic Center Affiliated With a Stroke Center

“…One of the main tenets in the management of CRAO is evaluation for the underlying cause (e.g., source of emboli or giant cell arteritis) with the goal of preventing a second ischemic event (15). To that end, there has been a rapidly growing consensus that patients with acute CRAO should be immediately referred to a local ED affiliated with a stroke center (3,(16)(17)(18)(19). The risk of another ischemic event in the subsequent weeks after a CRAO is high; one study found that 32% of patients had a stroke, myocardial infarction, or died within 2 years after a CRAO (20).…”

“…Despite the importance of visual loss being a symptom of stroke, BE-FAST (or other mnemonics including visual symptoms) have not yet been widely adopted and patient care remains delayed (28). A recent study of patients with acute CRAO presenting within 2 weeks to an outpatient retina practice in the United States showed critical delays in "time to workup" in outpatient referrals (13.6 days) vs the ED (2.2 days) (19). Whereas we strongly agree with their proposition that all eye care providers establish a relationship with a stroke center for urgent referrals (and that screening for giant cell arteritis occur in all patients over 50) (15), it is essential that referral pathways be simplified and that the entire workup be deferred to the expert stroke neurologist in the ED.…”