By AMERICAN HEART ASSOCIATION NEWS
Most patients who suffer a stroke in the eye don’t get a follow-up evaluation that could help prevent them from later having a traditional – and potentially far more debilitating – stroke in the brain, according to a new study.
An eye stroke, or retinal infarction, occurs when blood flow is blocked in the arteries of the retina. A sudden loss of vision in some or all of the eye is the most common symptom of an eye stroke.
But only about one-third of the eye stroke patients examined in a recent study ever underwent any type of evaluation to assess their risk for having a classic stroke. And fewer than one in 10 patients were ever seen by a neurologist, according to the findings presented Thursday at the American Stroke Association’s International Stroke Conference in Los Angeles.
“I was probably most surprised by that [finding] – you’re having a stroke to the eye, which is a part of the brain, and yet you’re not being seen by a neurologist?” said Dr. Alexander Merkler, the study’s lead author and a neurologist at Weill Cornell Medicine in New York.
“Typically, if you have a stroke in the brain, you will be seen by a neurologist, evaluated for why that stroke occurred, and treated,” he said. “But what we found is that these patients who had a stroke to the eye weren’t getting the same kind of risk-factor evaluations or referrals.”
Both can be critical since one in 100 of the eye stroke patients in the study had a cerebral stroke within 90 days.
The main risk factors for an eye stroke are similar to those for a classic stroke, primarily high blood pressure, high cholesterol, diabetes or a type of irregular heart rhythm called atrial fibrillation.
Treatment for an eye stroke depends on what may have caused it. If it’s triggered by an irregular heart rhythm, blood thinners may be prescribed, Merkler said.
But eye strokes also could stem from a buildup of fatty plaque in the neck. And while patients who experience traditional strokes usually get imaging tests of the carotid arteries in their neck, only about one-third of eye stroke patients ever got a similar type of scan, according to the study which examined 5,688 Medicare patients with retinal infarctions from 2009 and 2015.
Strokes are the nation’s fifth leading cause of death, accounting for one in every 20 deaths a year. About 87 percent of all strokes are classified as ischemic, which means blood flow to the brain is blocked.
Eye strokes are less common than brain strokes, but they also may be underreported, said neurologist Dr. Ralph L. Sacco, neurology chairman at the University of Miami Miller School of Medicine.
“Not everybody who has an eye complaint gets to a doctor and finds out whether it could have been an eye stroke or not,” said Sacco, president of the American Academy of Neurology.
He compared eye strokes to transient ischemic attacks, also called “mini-strokes” because their symptoms – including slurred speech, sudden headache, weakness on one side of the body – often are viewed as warnings of a full-scale stroke.
“The arteries in the retina are considered part of the nervous system, part of the brain, so eye strokes should be treated just as seriously as brain strokes. They should be viewed just like warning signs of a bigger stroke,” Sacco said. “If you lose sudden vision or partial vision in an eye, you need to get to a doctor and have an evaluation to make sure you’re not at risk for a brain stroke.”
Merkler said he would like to see the issue heightened among medical professionals. More ophthalmologists need to ensure their eye stroke patients get appropriate follow-up.
“At a minimum, they need to be sent to either a cardiologist or neurologist for a stroke risk evaluation,” he said. “But I think neurologists also need to do a better job of educating patients and other physicians about strokes to the eye and the need for these patients to get the same kind of tests that someone with a brain stroke would receive.”
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