CRAO Care Should Mimic Cerebral Stroke Management

Hospital emergency, medical staff pushing patient on gurney.
Researchers indicate a need to increase awareness both among the general public and fellow clinicians.

The following article is a part of conference coverage from the 2021 meeting of the North American Neuro-Ophthalmology Society, being held virtually from February 20 to 23, 2021. The team at Ophthalmology Advisor will be reporting on the latest news and research conducted by these leading experts in neuro-ophthalmology. Check back for more from the NANOS 2021 Meeting.


Central retinal artery occlusion (CRAO) should be managed similarly to a cerebral stroke, and patients should be urgently referred to an emergency department with a stroke center for treatment, according to research presented at the North American Neuro-Ophthalmology Society (NANOS) 2021 Annual Meeting. The conference was held virtually February 20 to 23, 2021. 

Researchers conducted a retrospective study to analyze referral patterns for patients with CRAO at a tertiary care center over the past 10 years. All patients diagnosed with CRAO at the Emory University Emergency Department between 2010 and 2020 were included. 

The total cohort included 181 patients with CRAO; median patient age was 69 years and 56% were men. Median patient body mass index was 28 kg/m2 (range, 17.6 kg/m2 to 67.5 kg/m2).

Investigators found that most patients saw numerous providers before receiving the appropriate referral. These data follow previous survey results indicating that 46% to 87% of neurologists send patients with acute CRAOs to emergency departments rather than to ophthalmologists (8% to 35%). 

Investigators also found that over the course of the study, the time to patient presentation to the first provider, the emergency department, and the Emory Eye Center did not improve over time. Frequency of patients evaluated as inpatients, though, did increase over time, improving from 44% between 2010 and 2013 to 82% between 2017 and 2020. 

Investigators emphasized that acute CRAO should be managed similarly to cerebral stroke. Patients experiencing acute CRAO should be sent “urgently” to an emergency department affiliated with a stroke center to undergo an immediate evaluation and treatment. 

“Patients continued to see multiple providers prior to presenting to our institution,” the research says. “Time to presentation did not significantly decrease from 2010 [to] 2020, [but there was a] trend for faster presentation to our institution over time.” 

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Flowers AM, Chan W, Meyer BI, Bruce BB, Newman NJ, Biousse V. Referral patterns of patients with central retinal artery occlusion to a large academic center. Presented at: North American Neuro-Ophthalmology (NANOS) 2021 Annual Meeting; February 20-23, 2021; Poster 90.