An innovative protocol diagnosing eye strokes, aiming to save vision has been developed by researchers.
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A Remote Consult Retinal Artery Occlusion Diagnostic Protocol
Go to source) 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.
‘A groundbreaking protocol for diagnosing eye strokes, offering potential for vision preservation. Remote consultations could enhance time-sensitive ophthalmic emergency care. #eyestroke #eyecare ’
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“The protocol implements highly sensitive retinal imaging at the patient’s point of entry into the medical system, reducing the need for onsite ophthalmology consults, which are often not immediately available,” says corresponding author Richard B. Rosen, MD, Chief of the Retina Service for the Mount Sinai Health System. “Seamless cooperation and coordination between the subspecialty teams of stroke neurologists, retinal specialists, and interventional radiologists is the key to rapid triage of these emergency patients. This model can easily be implemented anywhere in the country where a stroke team is available, The semi-automated OCT camera and remote consult team can expedite diagnosis for these time-sensitive eye emergencies.”
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Recognizing Sudden Vision Loss as a Potential Sign of Eye Stroke
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.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 6 to 12 hours of losing vision, or it will lead to permanent vision loss.
To expedite care, 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, pioneered at NYEE, 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. 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. The average time to treatment after the patients arrived at the hospital was roughly two and a half hours. Patients were treated, on average, about nine hours from the onset of symptoms, which included the time the patients took to come to the hospital.
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Next steps for the Mount Sinai researchers’ campaign to improve eye stroke outcomes will include expanding the availability of OCT cameras in more Mount Sinai Health System emergency rooms and increasing outreach to the medical community and the general public. The goal is for people to better understand symptoms of eye stroke and the importance of getting immediate medical attention, and recognize the potential for treatment to preserve vision with a timely referral.
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Reference:
- A Remote Consult Retinal Artery Occlusion Diagnostic Protocol - (https://www.aaojournal.org/article/S0161-6420(23)00910-7/fulltext)