Low uptake of stroke testing following retinal infarction
Despite guidelines advocating stroke risk factor assessment following retinal infarction (stroke of the eye), adherence to the guidelines within 90 days of infarct was poor among elderly patients, leading to a potentially elevated risk of stroke, according to a study presented at the recent International Stroke Conference 2018 (ISC 2018) in Los Angeles, California, US.
“We found that in a large, heterogenous population of patients [with retinal infarction], only about a third of them underwent the recommended stroke risk factor evaluation,” said study lead author Dr Alexander Merkler, a neurologist from the Weill Cornell Medical Center in New York City, New York, US.
Using data from Medicare claims between 2009 and 2015, the researchers identified 5,688 patients aged ≥65 years who had been diagnosed with retinal infarction by an ophthalmologist.
Within 90 days of a retinal infarction, less than one-third of patients underwent heart-rhythm testing (28.6 percent), while 34.1, 23.3, and 8.4 percent of patients underwent cervical carotid imaging, echocardiography, and neurologist evaluation, respectively. [ISC 2018, poster TMP76]
The cumulative risk of ischaemic stroke at 90 days was 1.0 percent, translating to one in 100 patients with a diagnosis of retinal infarction developing an acute ischaemic stroke within 90 days of the infarct.
According to Merkler, many individuals do not realize that the eye is part of the brain and that eye strokes can occur, with a common symptom being sudden loss of vision or sudden loss of partial vision.
If this occurs, prompt physician consult for eye examination is vital. Once the diagnosis of retinal infarction is confirmed, the patient should undergo a stroke risk factor evaluation which would include, among others, assessments for high blood pressure, diabetes, smoking cessation, as well as carotid artery disease, heart arrhythmias, and structural heart problems, he said.
“Discovering those types of stroke risk factors can help prevent a subsequent full-blown stroke or a full ischaemic stroke of the brain,” said Merkler.
While education is key in raising awareness that sudden vision loss may be due to a stroke, physician education is also crucial.
“Our research tells us that we need to do a better job at evaluating patients with retinal infarction and making sure they receive the same standard-of-care tests that someone with a stroke in the brain would have. We need to work more closely with ophthalmologists to ensure patients with stroke of the eye get the appropriate tests and treatments in a timely manner,” he said.