The background.
Recently, the American Academy of Ophthalmology (AAO) published an updated position statement on workup for patients diagnosed with central (CRAOs) or branch retinal artery occlusions (BRAOs).
These AAO guidelines mandate a substantial change in the current practice pattern, with urgent referral to a stroke center for any RAO.
The study details
A study published in Ophthalmic Epidemiology examined the referring patterns for patients with RAOs. More than 18,000 patients with new artery occlusions between the years of 2002 to 2020 were included in the study.
What did they find?
Among the patients identified with new RAOs only 4.1% were seen in the emergency department (ED) on the same or following day.
The rates of referral were significantly different based on provider specialty, with 10.8% coming from neurologists, 4.2% from ophthalmologists, and 3.4% from other providers.
Has the referral rate increased over the years with the changing guidance?
It has. The percentage of patients who went to the ED after diagnosis steadily rose over the observation period, starting at 0.3% in 2002 and increasing to 29% in 2019 (before falling to 14% in 2020). The odds of having an ED referral in 2020 were 22.8 times greater than in 2002.
The take home.
The authors state that it has become more common for the full workup to be completed and the current AAO guidelines followed; however, the most recent rates suggest there is still work to be done.