UK Stroke Forum 2025 | Optimizing outcomes in acute central retinal artery occlusion

I think this is a great question. And I think the first thing is for pre-hospital has to recognise that monocular visual loss could represent a central retinal artery occlusion, and working with ophthalmology, having pathways for us to rapidly see these patients, whether that be in a hyperacute stroke unit or if it’s a resolved event in a TIA clinic. And I think that’s the first step, good working relationships with ophthalmologists. And we, as a result of this, have set up an eye stroke MDT to discuss the outcomes of our cases, to talk about advanced imaging, for example, we’re using things like OCT and OCTA. So I think that’s a very first step.
And then I think it’s an understanding of, well, what is the sensitivity of the retina? And studies have shown that the retina is an extremely oxygen-requiring organ – it’s very sensitive to ischemia. And probably you need to be reversing changes within 90 minutes and just about up to four hours. So interventions that may have a benefit have to be done early, and that means that we have to identify these patients quickly. And therefore, that’s the only way we’re going to get better, I guess, effective interventions. There is one other point, and that is patients presenting with retinal ischemia, whether transient or occlusive, like central or branch retinal artery occlusion, do represent a real opportunity for prevention. These patients in the longer term have risks of stroke, death, and myocardial infarction. So if nothing else, we should be using this as a good opportunity for prevention.

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