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The authors present a retrospective case note review of all adult patients referred for or diagnosed with central retinal artery occlusion (CRAO) to a single tertiary hospital over a 10½ year period. A total of 181 patients were included in the analysis. The median time taken from onset of vision loss to first healthcare provider encounter was 24 hours and to assessment at the tertiary centre was 72 hours. Neither of these changed significantly over the 10-year period. The authors hypothesise that this delay is due to lack of public knowledge of equivalence of CRAO to stroke. Patients that had no previous ocular history or stroke were quicker to present to a healthcare provider than those with pre-existing ocular history or stroke. Ninety percent of patients presented to either outpatient eyecare or an emergency department. An improvement is reported of almost double the number of patients receiving a comprehensive stroke specialist assessment over the 10-year period. The authors call for simplification of referral pathways to enable these patients to receive timely potentially sight and / or lifesaving treatment. The limitation of the retrospective methods of this study are acknowledged by the authors. This study highlights the importance of educating the general public and other healthcare providers to visual symptoms associated with CRAO / stroke and improving care pathways to allow provision of better patient care and enable research into hyper-acute therapy of CRAO.

Referral patterns of central retinal artery occlusion to an academic center affiliated with a stroke center.
Flowers AM, Chan W, Meyer BI, et al.
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Lauren R Hepworth

University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.

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