S D Med. 2026 May;79(suppl 5):s48-s49.
ABSTRACT
INTRODUCTION: Central retinal artery occlusion (CRAO) is an ophthalmic emergency analogous to acute ischemic stroke, presenting with sudden painless vision loss and carrying a poor visual prognosis. The use of thrombolysis in managing CRAO remains controversial; recent randomized trials have not demonstrated statistically significant improvement in visual outcomes, though authors acknowledge potential underpowering to detect a clinically meaningful effect, with larger trials ongoing. Observational data suggest time-dependent treatment effects within a 4.5-hour window. Regardless of treatment efficacy, rapid recognition and evaluation within this narrow therapeutic window are essential for time-sensitive intervention. This study evaluated CRAO incidence and barriers to timely diagnosis within a regional healthcare system.
METHODS: Retrospective chart review of patients diagnosed with CRAO across Avera Health facilities (June 2018-September 2025). Cases were identified using ICD-10 codes and confirmed through medical record review. Thrombolysis rates were used as a process measure to identify workflow inefficiencies. Data included presentation site, referral pathways, time from symptom onset to presentation, and thrombolysis eligibility and administration.
RESULTS: Of 107 patients identified, 67 had complete documentation. Initial presentation occurred across multiple settings: 36 (53.7%) to the emergency department, 31 (46.3%) to ophthalmology/optometry/outpatient settings. Forty-three patients (64.2%) presented >4.5 hours after symptom onset. Among 24 presenting within the window, 7 (29%) received thrombolysis, 4 (16.7%) had contraindications to thrombolysis, and 13 (54.2%) either presented to or were referred to ophthalmology for evaluation, all of whom were diagnosed outside the treatment window.
CONCLUSION: Timely CRAO evaluation remains uncommon due to delayed presentation and diagnostic delays awaiting ophthalmologic consultation. Among patients presenting within the treatment window, just 45.8% received time-sensitive treatment options. Referral for ophthalmologic evaluation prior to emergency department diagnosis was the most common barrier (54.2%). Streamlined triage pathways, emergency department education, and remote retinal imaging may facilitate earlier diagnosis and preserve treatment opportunities.
PMID:42526019
