In a new retrospective study from LVPEI, Yogita Kadam, Dr. Brijesh Takkar, and others presented the clinical profile, impact, and outcomes of retinal artery occlusion, a sight-threatening emergency.
Hypertension and high blood cholesterol are detrimental to cardiovascular health. Cholesterol plaque deposits in our arteries result in blockages, increasing the risk of a heart attack. Such deposits, when they block the retinal artery, can result in sudden and irreversible vision loss. When a blood vessel is blocked, such as by a blood clot (embolus), it cuts off blood supply to the retina, the photosensitive layer of the eye, creating an ophthalmic emergency known as retinal artery occlusion (RAO). The lack of oxygen (hypoxia) starts killing the retinal cells, causing a sudden loss of vision. RAO requires immediate medical attention, with an estimated four-hour window of potential good recovery. Interventions include eye massages to dislodge the block, draining fluids from the anterior chamber of the eye to reduce intraocular pressure (IOP), and injecting drugs to dissolve the clot. Almost all interventions are too late and have a poor prognosis.
Retinal artery occlusion is a rare, sight-threatening condition. It is classified as central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), and cilioretinal artery occlusion (CLRAO) based on the location of the clot. There is limited understanding of RAO, especially its variants. This is particularly true of RAO data from India, due to the rarity of the condition, its sudden onset, and the finality of its outcomes. India has a large at-risk population for cardiovascular diseases, and it is important to understand this population’s susceptibility to RAO. LVPEI, a major eye care network in India, has a large patient base and an electronic medical record system to provide much-needed insight on this issue.
In a new study published in the Indian Journal of Ophthalmology, Yogita Kadam, Dr. Brijesh Takkar, and others from LVPEI present the clinical profile, impact of presentation, and outcomes of RAO. The retrospective study included the electronic medical records of 3070 patients with RAO who came to LVPEI. This number includes patients with BRAO, CRAO, and CLRAO types. Most patients were men (71.40%) and had RAO in only one eye (96.81%). Nearly half of the patients (46.25%) were either in their fifties or sixties.
The study only found a limited association between systemic conditions like hypertension (23%) and diabetes (14.79%) and RAO, though patients with hypertension had worse outcomes compared to those who did not. CRAO was the most common type of RAO (77.11%), BRAO was uncommon (15.78%) while CLRAO was rarely noted. The presence of retinal embolus, although rare (0.56%), accounted for 60% of serious systemic disorders. In the end, only 10% of patients improved their vision—those who presented within 6 hours of symptoms had better visual outcomes. Such poor outcomes underscore the need for awareness of RAO and its risk factors among the public. There is a need to surveil for, and identify, systemic risk factors that could help in predicting at-risk individuals.
'Certain serious and potential mortal health conditions may be detected following the occurrence of RAO, which vary with the age of the individual. RAO, especially CRAO, has very poor outcomes, specifically when managed late,' notes Dr Brijesh Takkar, corresponding author and consultant ophthalmologist at LVPEI. 'In this largest clinical study on CRAO till date, we found that majority of patients present late when therapy does not change much. This needs to be rectified for better results through awareness and facilitation.'
Citation
Kadam, Y., Das, A. V., Narayanan, R., Balakrishnan, N., Telukunta, P., & Takkar, B. (2025). Profile and outcomes of retinal artery occlusion: The underrealized need to expedite presentation. Indian Journal of Ophthalmology, 73(Suppl 1), S72–S77. < href='https://doi.org/10.4103/IJO.IJO_1686_24' target='_blank'>https://doi.org/10.4103/IJO.IJO_1686_24
Photo credit: Figure 2, Kadam et al.
