Recent Practice Patterns in Acute Retinal Artery Occlusions in the United States

ABSTRACT

Purpose

To determine how to practice patterns for work-up of incident retinal artery occlusion (RAO) compare to the American Academy of Ophthalmology (AAO) guidelines.

Methods

In this cohort study, patients receiving a new diagnosis of RAO, either central (CRAO) or branch (BRAO), were identified between 2002 and 2020 from a large US medical claims database. Claims were reviewed for diagnostic tests specified by the AAO as essential components of an RAO work-up including carotid ultrasound, echocardiogram, magnetic resonance imaging (MRI) and emergency department (ED) referral. Outcomes included rates of and time to completion of work-up.

Results

18697 new outpatient diagnoses of RAO (11348 BRAO, 7349 CRAO) were analyzed. 15.9% and 30.4% of patients received carotid ultrasounds within 7 and 30 days, respectively. 9.4% and 21.1% of patients received echocardiograms within 7 and 30 days, respectively. 4.9% and 8.1% of patients received a brain MRIs within 7 and 30 days, respectively. Only 4.1% of patients were referred to the ED within a day of diagnosis. Ophthalmologists diagnosed the majority (78.7%) of RAOs compared to neurologists (0.6%). Patients diagnosed by ophthalmologists were significantly more likely to have carotid ultrasound within 7 days, but those diagnosed by neurologists were more likely to have echocardiogram, MRI, and ED referral (p < .01 for all comparisons). The rates of adherence to the AAO care guidelines increased significantly between 2002 and 2020 (p < .01).

Conclusions

The referral and work-up practices demonstrated in this new RAO diagnosis patient cohort have improved with time but are still far below the standard recommended by the AAO.

Keywords:

• Retinal Artery Occlusion
• care trends
• emergency management

Acknowledgments

Financial Support: National Institutes of Health K23 Award (1K23EY025729 - 01) and University of Pennsylvania Core Grant for Vision Research (2P30EY001583). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding was provided by Research to Prevent Blindness, Karen & Herbert Lotman Fund for Macular Vision Research Foundation, and the Paul and Evanina Mackall Foundation. None of the funding organizations had any role in the design or conduction of the study.

Data availability

Brian VanderBeek had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Data analysis and interpretation

Meer, Scoles, McGeehan, VanderBeek

Data collection

McGeehan, Hua, VanderBeek

Disclosure statement

No potential conflict of interest was reported by the author(s).

Manuscript preparation

Meer, Scoles, McGeehan, VanderBeek

Obtaining funding

VanderBeek

Research design

Scoles, VanderBeek

Supplemental data

Supplemental data for this article can be accessed on the publisher’s website

Additional information

Funding

National Institutes of Health K23 Award (1K23EY025729 - 01) and University of Pennsylvania Core Grant for Vision Research (2P30EY001583). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding was provided by Research to Prevent Blindness, Karen & Herbert Lotman Fund for Macular Vision Research Foundation, and the Paul and Evanina Mackall Foundation. None of the funding organizations had any role in the design or conduction