Novel protocol allows remote diagnosis of retinal artery occlusion

Remote consultation using point-of-care automated optical coherence tomography (OCT) is feasible in the diagnosis of retinal artery occlusion, suggests a study.

Fifty-nine adult patients who presented with painless monocular vision loss and had a diagnosis of nonarteritic retinal artery occlusion were evaluated in the first 18 months since the protocol went live. The authors placed OCT machines in the stroke centre or emergency department in three hospitals. Participants were assessed by the stroke neurology service and tasked to undergo an OCT.

The retina service interpreted the images remotely, and an in-house ophthalmology consult was not required to make the final treatment decision. Patients were then treated with intra-arterial tissue plasminogen activator (IA-tPA) and followed by ophthalmology during their admission when an in-house consultation service was available. Otherwise, they were assessed immediately following discharge.

Of the patients, 25 (42 percent) had a confirmed retinal artery occlusion based on OCT and follow-up examination. Ten patients met the eligibility criteria for treatment, and nine were treated with IA-tPA.

Mean visual acuity (VA) significantly improved from logarithm of the minimum angle of resolution (logMAR) 2.14 to logMAR 0.7 within 24 h of treatment (p=0.0001) and logMAR 1.04 after 4 weeks (p=0.01). Sixty-six percent of patients had a clinically significant improvement within 24 h, and 56 percent of all treated patients maintained this improvement through 1 month.

Additionally, the mean time to treatment was 543 min from last known well and 146 min from presentation at the stroke centre.

“This novel paradigm demonstrates the potential utility of remote consult services for the diagnosis of time-sensitive ophthalmic emergencies,” the authors said.