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Central retinal artery occlusion (CRAO) has been linked to a higher risk of undiagnosed cardiovascular problems than previously believed, according to a recent German study.
Hannover, Germany-Central retinal artery occlusion (CRAO) has been linked to a higher risk of undiagnosed cardiovascular problems than previously believed, according to a recent German study.
“Acute non-arteritic CRAO is an emergency and awareness should be higher than at present,” said Amelie Pielen, MD, co-author of the study, which was published in Ophthalmology, the journal of the American Academy of Ophthalmology (AAO).
Strokes in the eye are among the most challenging diseases in ophthalmology, and while there is no current standard of care for the acute management of the condition, it has been long recognized that there is a connection between the strokes and cardiovascular risk factors, reported the AAO.
Previous studies have used non-standardized medical examinations or research methods, which led to inconsistent results.
“Treatment options of the eye are very limited following non-inflammatory central retinal artery occlusion (NI-CRAO) as there is no therapy available, which could prove efficacy in a prospective and randomized clinical trial,” said Dr. Pielen, also of University Eye Hospital, Hannover, Germany.
Dr. Pielen explained that the promising treatment option of intra-arterial fibrinolysis was tested in the European Assessment Group for Lysis in the Eye trial. However, the functional results were disappointing, as the selective intra-arterial fibrinolysis was not superior to standardized conservative therapy.
The trial was terminated after safety analysis in favor of the conservative treatment, she added. It is still one of very few prospective clinical trials investigating acute non-arteritic CRAO. â¨
To better understand cardiovascular risk factors in eye stroke patients, the German study was conducted.
“Due to those disappointing results, (the new study’s) aim was to draw conclusions to help and give advice to CRAO patients, but also to treating ophthalmologists and cooperating physicians regarding cardiovascular risk factors,” Dr. Pielen said. “We therefore investigated cardiovascular risk factors in this unique homogenous prospective group of patients, although some general health analysis have already been performed during the last decades in NI-CRAO patients looking for systemic risk factors.
“As NI-CRAO is a rare event (1:100,000) those analysis took a long period of time and diagnostics quality changed notably,” she continued.
Nevertheless, the results were highly surprising, Dr. Pielen said.
“We did not expect such a high rate of cardiovascular risk factors in our study,” she said.
The study found a high percentage of patients with carotid artery stenosis, and 5 patients experienced a stroke within 4 weeks after CRAO, Dr. Pielen explained.
Additionally, the researchers were surprised to discover that while risk factors were present in 67% of CRAO patients in their medical history, comprehensive workup identified at least one new risk factor in 78% of the CRAO patients.
Furthermore, 31 (40%) patients had carotid artery stenosis of at least 70% and 11 patients experienced a stroke. Arterial hypertension was found in 56 (73%) patients and was newly diagnosed in 12 (16%) study participants. Cardiac diseases were also highly prevalent (22% coronary artery disease, 20% atrial fibrillation, and 17% valvular heart disease).
The study also found that risk factors are more prevalent in CRAO patients and stroke risk is 2.7-fold higher in CRAO patients compared to controls.
“To prevent stroke in CRAO patients, all patients need a prompt comprehensive work up of cardiovascular risk factors,” stressed Dr. Pielen.
“Ophthalmologists' diagnosis of acute non-arteritic CRAO should be followed by prompt workup of cardiovascular risk factors in close cooperation with primary care physicians, cardiologists and neurologists,” Dr. Pielen continued. “We would favor a prompt coordinated comprehensive workup in specialized units, such as stroke units.”
To expand awareness of the risks presented by eye strokes, Dr. Pielen said the study’s researchers are working on recommendations and SOPs on local levels to better establish and coordinate a prompt and optimal workup of patients with acute non-arteritic CRAO in cooperation with ophthalmologists, primary physicians, neurologists and cardiologists.
“Such standard operations could also serve to examine patients with partial retinal artery occlusions and amaurosis fugax based on similar ethiology,” she concluded.
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