Collaborative care for retinal artery occlusion by ophthalmologists and vascular neurologists: management of systemic complications.

Abstract

Purpose: Retinal artery occlusion (RAO) is frequently associated with cerebrovascular and cardiovascular events, and guidelines highlight the need for secondary prevention. Since 2019, our hospital has implemented collaborative care between ophthalmologists and vascular neurologists for acute RAO, and here, we report the clinical outcomes before and after this approach.

Study design: Retrospective observational study.

Methods: Eighty-seven patients (mean age: 72.2 ± 13.4 years; 40 male) diagnosed with central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), or cilioretinal artery occlusion (CLRAO) at Kyushu University Hospital between March 2013 and May 2024 were retrospectively analyzed, and information on patient backgrounds, ocular and systemic examinations, and treatments was obtained.

Results: The disease types were CRAO in 58, BRAO in 24, and CLRAO in 5 patients. Systemic complications before and after collaborative care included hypertension (67% before vs 79% after), diabetes (28% vs 17%), dyslipidemia (41% vs 44%), cerebrovascular diseases (21% vs 10%), carotid artery diseases (18% vs 40%, P = 0.03), and cardiac diseases (3% vs 27%, P = 0.002). After initiation of collaborative care, the causes of RAO were identified as large-artery atherosclerosis (LAA) in 29%, cardioembolism (CE) in 23%, undetermined in 38%, other determined in 8%, and insufficient evaluation in 2% of the patients. Anticoagulants were commonly prescribed for patients with CE, whilst antiplatelet agents were prescribed for those with LAA or embolic stroke of undetermined source (ESUS).

Conclusion: Integrated collaborative care facilitates prompt detection of systemic vascular complications and initiation of secondary preventive treatments in patients with RAO.