Ophthalmologists develop novel protocol to rapidly diagnose and treat eye stroke

Key Takeaways

  • Current protocols for diagnosing eye stroke can lead to crucial delays in diagnosis and treatment.
  • A new protocol allows for rapid diagnosis to expedite care and prevent irreversible vision loss.  

Painless, sudden vision loss in one eye may be a sign of an eye stroke, also known as central retinal artery occlusion. It happens when the main artery that supplies blood to the retina is blocked, typically by a clot, depriving the retina of oxygen. It is similar to a stroke in the brain. 

After an eye stroke, the retinal nerve cells that allow you to see die within hours unless blood flow is restored. The clot needs to be dissolved as soon as possible, ideally within six to 12 hours of losing vision, or it will lead to permanent vision loss. Unfortunately, under current protocols, ophthalmologists must dilate the eyes of suspected patients and evaluate them. If an ophthalmologist is not on call, there can be significant delays in diagnosis, says Gareth Lema, MD, PhD, of the Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, co-author of a new study.

Lema and colleagues created a novel protocol to rapidly diagnose eye stroke and expedite care to prevent irreversible vision loss. Their study, published in Ophthalmology, describes using high-resolution retinal imaging in the emergency room, along with rapid remote consultation to confirm diagnosis and expedite care, improving outcomes for eye stroke patients and preserving vision.  Corresponding author Richard B. Rosen, MD, Chief of the Retina Service for the Mount Sinai Health System, said, “This model can easily be implemented anywhere in the country where a stroke team is available.”

For the study, Mount Sinai’s Department of Ophthalmology launched an Eye Stroke Service and developed a treatment protocol for patients. High-tech eye imaging devices using optical coherence tomography (OCT) were placed in three hospitals within the Mount Sinai Health System that have large emergency rooms and stroke teams. OCT diagnostic imaging is a non-invasive way to detect microscopic changes in the retina within minutes of a blockage, enabling rapid diagnosis for accurate treatment.

When a patient arrives at the emergency room with a possible eye stroke, the stroke service is urgently called to evaluate the patient and do the scan, which takes about 2 minutes. They electronically send the images to remote on-call retinal specialists who can make an instant diagnosis. If the retinal specialists confirm an eye stroke diagnosis, the vascular interventional neuroradiologists can dissolve the clot with an infusion of tissue plasminogen activator (tPA)—a clot-dissolving drug—into the blocked ophthalmic artery.

Researchers analyzed 59 patients who went through the protocol on the Eye Stroke Service during the first 18 months since it launched. While the researchers haven’t yet published comparison data, Lema said the time from arrival to treatment has shrunk from a mean of about 350 minutes to 146 minutes, a savings of 2 hours. 

Edited by Dawn Wilcox BSN RN and Miriam Kaplan PhD.

Sources:

Randy Dotinga, MedPage Today, February 14, 2024; see MedPage Today article The Mount Sinai Hospital, Medical Xpress, February 13, 2024; see Medical Xpress article