Central Retinal Artery Occlusion Visual Outcomes from a Large Northern California Cohort

Purpose: To assess visual acuity (VA) outcomes in a large cohort of patients diagnosed with nonarteritic central retinal artery occlusion (CRAO), and to ascertain whether time from symptom onset to presentation, presenting VA, or conservative treatment delivery (anterior chamber paracentesis, ocular massage, intraocular pressure lowering drugs, hyperventilation, or some combination of those) impacted ultimate VA outcomes. Design: Retrospective cohort study. Subjects: 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 >= 90 days postdiagnosis. Methods: Retrospective chart review was conducted for all patients with a diagnosis of CRAO initially identified via International Classification of Diseases coding, followed by confirmation of diagnosis by 2 retina specialists. Cases of arteritic CRAO were excluded. Main Outcome Measures: Visual acuity recovery, defined as improvement from <= 20/200 or worse at presentation to >= 20/100 >= 90 days after diagnosis. Results: 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 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 P < 0.05) in VA outcomes between patients who did or did not receive conservative treatment. Conclusions: 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. (c) 2023 by the American Academy of Ophthalmology