Vision loss demands immediate action, especially when it stems from retinal artery occlusion (RAO), a condition requiring rapid diagnosis and treatment to preserve sight. In New York (NY), like many regions, timely access to retinal specialists can be a bottleneck in emergency care settings. This article explores a groundbreaking protocol implemented within a New York health system, leveraging point-of-care Optical Coherence Tomography (OCT) and remote consultation to expedite the diagnosis and treatment of RAO in emergency departments and stroke centers. This innovative approach significantly improves the speed of “Ny Retinal Diagnosis,” paving the way for better patient outcomes in time-sensitive ophthalmic emergencies.
This retrospective case series meticulously evaluated the effectiveness of this novel diagnostic technology within three hospitals in the NY area. The study focused on adult patients presenting with sudden, painless vision loss – classic symptoms of nonarteritic retinal artery occlusion. To streamline the diagnostic process, OCT machines were strategically placed within the stroke centers and emergency departments of these NY hospitals. When patients presented with acute monocular vision loss, the stroke neurology service initiated an OCT scan. Crucially, these images were then transmitted for remote interpretation by retina specialists. This remote consultation model eliminated the need for immediate in-house ophthalmology consultation to make critical treatment decisions, thereby accelerating the pathway to intervention. Patients diagnosed with RAO under this protocol were eligible for and treated with intra-arterial tissue plasminogen activator (IA-tPA). Post-treatment, patients received ophthalmological follow-up, either during their hospital stay, if in-house consults were available, or immediately post-discharge.
The primary outcome measures rigorously assessed the impact of this rapid “ny retinal diagnosis” protocol. Visual acuity (VA) was measured both before and after IA-tPA treatment. The study also meticulously tracked the critical time metrics: time from last known well (LKW) to treatment initiation and time from patient presentation at the stroke center to treatment. Over an initial 18-month period following protocol implementation, a significant cohort of 59 patients presenting with acute vision loss were evaluated in NY hospitals using this system. Among these, 25 patients (42%) received a confirmed diagnosis of retinal artery occlusion based on OCT imaging and subsequent ophthalmological examination, demonstrating the accuracy of “ny retinal diagnosis” via remote OCT interpretation. Of those diagnosed, ten patients met the eligibility criteria for IA-tPA treatment, and nine ultimately received this sight-saving intervention.
The results showcased a compelling improvement in visual outcomes. A statistically significant enhancement in mean visual acuity was observed within just 24 hours of treatment, improving from a baseline logarithm of the minimum angle of resolution (logMAR) of 2.14 to 0.7 (P = 0.0001). This improvement was sustained at the 4-week mark, with mean VA at logMAR 1.04 (P = 0.01). Clinically significant visual improvement was noted in 66% of patients within the first 24 hours, and this benefit persisted in 56% of treated patients at one month. The efficiency of the “ny retinal diagnosis” and treatment pathway was further underscored by the mean time to treatment from LKW being 543 minutes and a notably shorter 146 minutes from presentation at the NY stroke center.
In conclusion, this study provides compelling evidence for the successful deployment of a remote consultation protocol utilizing point-of-care automated OCT for “ny retinal diagnosis” and treatment of retinal artery occlusions within a New York healthcare network. This innovative model highlights the substantial potential of remote consultation services to transform the diagnosis and management of time-critical ophthalmic emergencies. By leveraging technology to bridge geographical and logistical gaps, this protocol offers a paradigm shift in delivering timely and effective care for patients suffering from RAO, not only in NY but potentially in other healthcare systems facing similar challenges in rapid ophthalmic diagnosis and intervention.
Financial disclosure(s): Proprietary or commercial disclosure may be found after the references in the original publication.
