Dr. Rani Banik dives into the complexities of retinal strokes, specifically central retinal artery occlusion (CRAO), a vision-threatening condition often called an “eye stroke.” Joined by esteemed retina specialist Dr. Richard Rosen, who brings decades of expertise and cutting-edge insights into retinal care, the episode explores the latest treatment advancements transforming CRAO outcomes.

From interventional radiology to swift diagnostic techniques, Dr. Rosen shares groundbreaking approaches that provide new hope in preserving sight when every second counts. “Time is of the essence with retinal strokes; every second counts for salvaging sight,” notes Dr. Richard Rosen, a leading retina specialist.

CRAO occurs when a blockage forms in the central retinal artery, typically from an embolus originating in another part of the body, like the carotid artery or the heart. CRAO presents as sudden, painless vision loss in one eye, with minimal chance of natural visual recovery. If left untreated, the retina’s oxygen-deprived state rapidly damages photoreceptors, leading to permanent vision impairment.

Historically, CRAO treatment was limited to methods like:

These interventions, however, produced limited results, prompting the medical community to explore more effective, science-driven solutions.

Interventional radiology is one of the most promising developments in CRAO treatment. It utilizes catheter-based procedures to deliver clot-busting drugs directly to the retinal artery. Here’s an overview of the procedure and its benefits.

Interventional Radiology

In interventional radiology, a catheter is threaded from the patient’s femoral artery to the ophthalmic artery. Here, a small dose of a thrombolytic drug, such as a tissue plasminogen activator (tPA), is injected directly into the occlusion site. Imaging technology, like choroidal blush, enables physicians to visualize the restoration of blood flow in real-time. Below are the advantages:

Incorporating OCT for Early Diagnosis

Incorporating optical coherence tomography (OCT) has been pivotal in early detection. Hospitals with advanced setups like the Mount Sinai system perform OCT scans immediately for patients presenting sudden vision loss, even before dilation. Automated OCTs in emergency departments allow quick access to imaging data, accelerating diagnosis and treatment initiation. “OCT’s role in detecting retinal ischemia early cannot be understated. It’s a crucial first step in mobilizing the care team swiftly,” says Dr. Rosen.

After initial intervention, a comprehensive cardiovascular assessment is essential, as CRAO patients have an elevated risk of stroke. This includes carotid ultrasounds, echocardiograms, and continuous monitoring for atrial fibrillation. For eye care providers, post-treatment care also involves vigilant observation for neovascularization, particularly in the first six months, to prevent secondary complications such as neovascular glaucoma. Below are some key recommendations:

A critical element in CRAO outcomes is the public’s understanding of ocular emergencies. Campaigns like BE FAST—Balance, Eyes, Face, Arm, Speech, and Time—raise awareness of stroke symptoms, including vision issues. However, there remains a gap in recognizing vision changes as an emergency. Dr. Rosen advises that if a patient experiences sudden vision changes, they should act like they’re experiencing a life-threatening event.

The advancements in CRAO treatment are ushering in a new era where immediate action and comprehensive care protocols give patients a fighting chance to retain their sight. For eye care professionals, staying informed about these options and collaborating with interdisciplinary teams is essential for achieving the best patient outcomes.“Vision is precious, and we only have one chance to save it when a stroke occurs. Early intervention isn’t just a luxury—it’s a necessity,” Dr. Rosen emphasizes.

As CRAO treatment continues to evolve, providers are encouraged to stay abreast of these innovations, advocate for patient awareness, and adopt a proactive approach to emergency care. Ultimately, this new approach has the potential to save not only vision but also lives.