Central Retinal Artery Occlusion Is Not Local Ocular Event – It Is a Marker for Subsequent Vascular Disease Such As Stroke and Ischemic heart Disease
Central retinal artery occlusion is an occlusion by a fibrin-platelet like thrombus or embolus, which results to reduced perfusion to the retina. This also leads to a painless visual loss that most often than not is irreversible. Similar to ischemic heart disease or stroke, pure cholesterol emboli or a platelet fibrin clot causes retinal ischemia due to central retinal artery occlusion. Now, atherosclerotic disease is the ultimate source for emboli as well as thrombi, which is why, the same risk factors accompanying atherosclerotic disease are the same ones prevalent in the patients who have central retinal artery occlusion.
Due to its pathogenesis, central retinal artery occlusion is similar to other vascular diseases like cerebrovascular disease and ischemic heart disease in terms of risk factors. According to the study of stroke and heart diseases, after a sentinel vascular occurrence, a patient is very likely to develop other subsequent vascular events. The same ting applies to Central retinal artery occlusion; following it might be even more serious vascular attacks, currently, managing Central retinal artery occlusion means, preventing a secondary ischemic attack. At presentation, the most prevalent risk factor is Hypertension but a considerable number of people had carotid artery stenoses that needed immediate intervention and those with 50-69% stenoses were also amenable to intervention.
Apart from the fact that there are risk factors documented before presenting central retinal artery occlusion, some people ad undiagnosed vascular risk factors. Some even needed to escalate their anti-hypersensitive medication or add more vascular preventative medication instead. It has not yet been proven that anti-hypersensitive, cholesterol lowering agents or anti-platelets actually do lower the risk of central retinal artery occlusion but they are still accepted as standard clinical medication for preventing stroke and ischemic heart disease.
Because it’s a disease process, central retinal artery occlusion is considered an ocular emergency but, treatment is limited because there is lack of effective acute treatments that are supported by actual robust evidence. Together with the low incidence, clinics have ignored any potential for secondary prevention of stroke, ocular ischemic as well as heart disease. Literature shows that there is pre-existing vascular risk factor before central retinal artery occlusion hypertension in the lead. Controlling such cases is important through either escalating or adding existing macro-vascular preventative medication following central retinal artery occlusion. Most studies have already shown central retinal artery occlusion as a maker for subsequent vascular disease like stroke and ischemic heart disease with significant mortality as well as morbidity and not just a benign disease.
A small part of the central retinal artery occlusion patients had a cerebral stroke, which mirrors the extent of the risks of ischemic attacks, which lead to a complete stroke. This means there is a need for aggressive pharmacotherapy in the secondary prevention of ischemic attacks. A patient should see a vascular physician regardless if they are stroke neurologists, internal medicine specialists or cardiologists who will offer such therapy as well as ongoing ophthalmology input.
Central retinal artery occlusion is not only followed by ischemia in vital organs but by retinal ischemia as well. One out of five people either had symptoms of transient monocular blindness or branch retinal artery occlusion. Half of the patients had previous ischemic heart attacks or stroke. If all these sentinel events are recognized early enough, central retinal artery occlusion can be prevented and if the patients start anti-platelets, cholesterol-lowering agents or anti-hypersensitive early, there will be a reduced risk of subsequent diseases like stroke and retinal artery occlusion.
What are the risk factors for central retinal artery occlusions ?
- Tobacco use
- Family history of vascular disease
- Diabetes Mellitus
- Atrial fibrillation
- Cardiomyopathy or valvular disease
- Renal artery stenosis (atherosclerotic)
In those central retinal artery occlusion where there are no atherosclerotic risk factors, especially in a young patient, following less common factors should be examined:
- Sickle cell disease
- Myeloproliferative disorders
- Hypercoagulable states
- Use of the oral contraceptive
What are the symptoms of a vein occlusion?
Patients with central retinal artery occlusion typically present with an acute, painless loss of vision with severe vision deterioration when visual acuity is decreased to counting fingers or even worse.
Due to different anatomical structure of vessels (existing of additional cilioretinal artery) some patients can preserve more visual acuity in compare with peripheral vision loss.
How is a vein occlusion diagnosed?
Eye specialist usually does following examinations:
- Anterior segment examination
- Fundoscopic examination revealed retinal ischemic
- Fluorescein angiography
- Optical Coherence Tomography
How is central retinal artery occlusions treated?
There are a number of therapies that has been used in the treatment of central retinal artery occlusion and include:
- Carbogen inhalation
- Acetazolamide infusion
- Ocular massage and paracentesis
- Assign of various vasodilators
Recently it has been interest shown in the use of thrombolytic therapy, delivered either intravenously or intra-arterially by direct catheterisation of the ophthalmic artery.
Finally any medical interventions aided to attempt to reperfuse ischemic tissue as quickly as possible and to institute secondary prevention early are required to be used.
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