Sohan Singh Hayreh1, M Bridget Zimmerman2. 1. Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa. 2. Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa.
Abstract
OBJECTIVE: To compare prevalence of carotid artery disease and its various types of lesions in different types of ocular arterial occlusive disorders. DESIGN: Cohort study. SUBJECTS: 614 consecutive patients (728 eyes) with ocular arterial occlusive disorders. METHODS: At first visit, all patients had a detailed ophthalmic and medical history, comprehensive ophthalmic evaluation, and carotid artery evaluation (by Doppler/angiography) on the side of ocular arterial occlusion, and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit. Ocular arterial occlusive disorders were divided into central (CRAO) and branch (BRAO) retinal artery occlusion, ocular ischemic syndrome (OIS), non-arteritic anterior ischemic optic neuropathy (NA-AION) and amaurosis fugax (AF). MAIN OUTCOME MEASURES: Carotid artery and echocardiographic abnormalities, and incidence of transient ischemic attack (TIA)/stroke and myocardial ischemia. RESULTS: The study consists of a cohort of 266 eyes with NA-AION, 203 with CRAO, 127 with BRAO, 80 with OIS and 52 with AF. Carotid artery stenosis on the involved side was worse in AF and OIS compared to BRAO, CRAO, and NA-AION (p<0.0001). Presence of carotid artery plaques on the involved side was significantly higher in OIS, AF, and CRAO compared to NA-AION (p=0.002, p=0.003, and p=0.0003, respectively). Echocardiography revealed an embolic source in 61% of CRAO and 53% of BRAO compared to only 3% of NA-AION patients (p<0.0001). TIA/stroke before or after onset of ocular condition occurred in 17% of OIS, 11% of AF, 7% of CRAO, 6% of NA-AION, and 3% of BRAO patients. Kaplan-Meier estimate of the incidence of TIA /stroke within 3 months after onset was 6% (95% CI: 2%, 17%) for OIS, 3% (95% CI: 0.4%, 19%) for AF, and 1% (95% CI: 0.3%, 4.1%) for CRAO. Report of myocardial ischemia before or after onset of ocular condition was 52% in AF, 22% in OIS, 22% in BRAO, 21% in CRAO, and 6% in NA-AION patients. CONCLUSIONS: The incidence of carotid artery stenosis and plaques, cardiac embolic source, TIA/stroke and myocardial ischemia differ among various ocular arterial occlusive disorders. The role of embolism and hemodynamic disturbances caused by carotid artery disease in these disorders is discussed.
OBJECTIVE: To compare prevalence of carotid artery disease and its various types of lesions in different types of ocular arterial occlusive disorders. DESIGN: Cohort study. SUBJECTS: 614 consecutive patients (728 eyes) with ocular arterial occlusive disorders. METHODS: At first visit, all patients had a detailed ophthalmic and medical history, comprehensive ophthalmic evaluation, and carotid artery evaluation (by Doppler/angiography) on the side of ocular arterial occlusion, and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit. Ocular arterial occlusive disorders were divided into central (CRAO) and branch (BRAO) retinal artery occlusion, ocular ischemic syndrome (OIS), non-arteritic anterior ischemic optic neuropathy (NA-AION) and amaurosis fugax (AF). MAIN OUTCOME MEASURES: Carotid artery and echocardiographic abnormalities, and incidence of transient ischemic attack (TIA)/stroke and myocardial ischemia. RESULTS: The study consists of a cohort of 266 eyes with NA-AION, 203 with CRAO, 127 with BRAO, 80 with OIS and 52 with AF. Carotid artery stenosis on the involved side was worse in AF and OIS compared to BRAO, CRAO, and NA-AION (p<0.0001). Presence of carotid artery plaques on the involved side was significantly higher in OIS, AF, and CRAO compared to NA-AION (p=0.002, p=0.003, and p=0.0003, respectively). Echocardiography revealed an embolic source in 61% of CRAO and 53% of BRAO compared to only 3% of NA-AIONpatients (p<0.0001). TIA/stroke before or after onset of ocular condition occurred in 17% of OIS, 11% of AF, 7% of CRAO, 6% of NA-AION, and 3% of BRAO patients. Kaplan-Meier estimate of the incidence of TIA /stroke within 3 months after onset was 6% (95% CI: 2%, 17%) for OIS, 3% (95% CI: 0.4%, 19%) for AF, and 1% (95% CI: 0.3%, 4.1%) for CRAO. Report of myocardial ischemia before or after onset of ocular condition was 52% in AF, 22% in OIS, 22% in BRAO, 21% in CRAO, and 6% in NA-AIONpatients. CONCLUSIONS: The incidence of carotid artery stenosis and plaques, cardiac embolic source, TIA/stroke and myocardial ischemia differ among various ocular arterial occlusive disorders. The role of embolism and hemodynamic disturbances caused by carotid artery disease in these disorders is discussed.
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