Retinal infarction requires better follow-up care to prevent future strokes

Only a third of patients with retinal infarction underwent basic evaluations for stroke risk and fewer than one in 10 were seen by a neurologist, according to research presented at the International Stroke Conference on Jan. 25 in Los Angeles.

This rate of follow-up is poor, the researchers said, considering retinal infarction is a form of ischemic stroke and shares many of the same risk factors as more dangerous brain strokes: high blood pressure, high cholesterol, diabetes and atrial fibrillation. In fact, 1 percent of the patients in the study went on to have another ischemic stroke within 90 days of a retinal infarction.

“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,” lead author Alexander Merkler, MD, a neurologist at Weill Cornell Medical Center in New York, said in a press release. “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.”

Merkler and colleagues studied Medicare ophthalmology claims between 2009 and 2015 to identify 5,688 patients with retinal infarction. Symptoms can include blurred vision or vision loss as well as tissue damage to the eye itself, according to the American Stroke Association (ASA).

Within 90 days of those symptoms, 34 percent of the patients received cervical carotid imaging tests, 28.6 percent received heart-rhythm testing, 23.3 percent underwent echocardiography and 8.4 percent were seen by a neurologist.

ASA spokesperson Larry B. Goldstein, MD, said blood tests and even ophthalmologists looking into a patient’s eye can help identify the type of blood vessel problem a patient is experiencing. He reiterated one of the manifestations could be a harbinger for another stroke, especially if proper action isn’t taken.

“The nonarteritic type is most commonly caused by atherosclerosis, hardening of the artery, the same processes that cause heart attack and stroke,” said Goldstein, the chairman of the Department of Neurology and co-director of the Kentucky Neuroscience Institute. “In that case, what we do is do a test to try to identify potential causes that may need to be managed in a specific way. For example, hardening of the arteries, an occlusion of an artery in the neck, or a potential cause that may be coming from the heart. We also do tests to identify risk factors, (the) same risk factors that we would be evaluating if a patient had a heart attack or a stroke.”

Merkler said he plans to further study connections between retinal infarction and stroke using brain MRI tests.