Central Retinal Artery Occlusion

To assess visual acuity (VA) outcomes in a large cohort of patients diagnosed with non-arteritic central retinal artery occlusion (CRAO), and to ascertain whether time from symptom onset to presentation, presenting visual acuity, or conservative treatment delivery (anterior chamber paracentesis, ocular massage, intraocular pressure lowering drugs, hyperventilation, or some combination of those) impacted ultimate VA outcomes. Retrospective cohort study. Participants, and/or Controls: The study included 794 patients who presented with CRAO between 2011 and 2020. Within this cohort, 484 individuals presented within 30 days of symptom onset and had comprehensive documentation regarding the details of their presentation, management, and follow-up at least 90 days post-diagnosis. Intervention, or Testing: Retrospective chart review was conducted for all patients with a diagnosis of CRAO initially identified via ICD coding, followed by confirmation of diagnosis by two retina specialists. Cases of arteritic CRAO were excluded. VA recovery, defined as improvement from < 20/200 or worse at presentation to > 20/100 at least 90 days after diagnosis. Of the 794 identified patients, 712 (89.7%) presented with VA of < 20/200. Similarly, 447 (92.4%) of the 484-patient subset that presented within 30 days and had comprehensive documentation, presented with VA < 20/200. Of the 441 of those patients with documented follow up, 380 (86.2%) remained at that level. Of the 244 patients who presented within 4.5 hours of symptom onset, 227 (93%) presented < 20/200 and 201 (92.6%) of the 217 of those with follow-up data did not improve beyond that threshold. There was no significant difference (p < 0.05) in final VA between patients presenting before versus after 4.5 hours from time of vision loss. There was also no significant difference (p < 0.05) in VA outcomes between patients who did or did not receive conservative treatment. This large retrospective study further highlights the poor visual prognosis for patients with CRAO. Earlier time to presentation did not seem to impact final VA outcome, nor did conservative treatment efforts. Efficacious evidence-based treatment options are needed for this patient population.