Branch retinal artery occlusion time to presentation and diagnosis: a retrospective review

TL;DR

This study finds that most patients with branch retinal artery occlusion experience significant delays in seeking or receiving timely eye care, highlighting the need for better public awareness and improved care workflows.

Contribution

The study provides novel insights into the patterns of delayed care for BRAO in a large community-based cohort, emphasizing the importance of early evaluation for diagnosis and risk mitigation.

Findings

Most patients with BRAO were not evaluated by an eye care provider within 24 hours of symptom onset.

Only 6.3% of patients with known symptom onset were seen by an eye care provider within 4.5 hours.

Delays in care were common, with 71.2% of patients experiencing delayed evaluation.

Abstract

Branch retinal artery occlusion (BRAO) is an acute, vision-threatening condition that often signals underlying systemic vascular disease and the need for urgent vascular risk assessment and mitigation. Although prompt evaluation is critical for accurate diagnosis and early identification of modifiable vascular risk factors, patterns of clinical presentation remain poorly characterized.

This retrospective study included BRAO patients who presented to Kaiser Permanente Northern California (KPNC) within 30 days of symptom onset from 2014 to 2023. Demographic data, symptom timing, healthcare contact, and ophthalmologic evaluation were collected. The type of contact was categorized as eye care provider, call center, emergency department/urgent care, or other. Delays in presentation were defined as time from symptoms to initial contact and were analyzed across subgroups.

From 2014 to 2023, 760 patients were diagnosed with acute BRAO. Mean age of the study population was 70.2 ± 12.6 years, and 330 (43.4%) were female. Initial contact most commonly occurred with eye care providers (370; 48.7%), followed by call centers (251; 33.0%), emergency/urgent care (73; 9.6%), and other providers (66; 8.7%). Only 219 (28.8%) presented within 1 day of symptom onset, while 97 (12.8%) presented after 8 days. The majority (541; 71.2%) were not evaluated by an eye care provider until > 24 h after symptom onset. Among the 153 (20.1%) with known time of symptom onset, median delay to any healthcare contact was 4.0 h. 80 (52.3%) patients presented within 4.5 h, but just 5 (6.3%) were seen by an eye care provider within that window.

In a large, multi-center, community population, delays in BRAO care were common. Although no Level 1 evidence currently exists to support BRAO treatment, success of future therapies will likely require early administration. Prompt evaluation is also critical to enable risk assessment and mitigation. Most patients in this cohort presented in a delayed fashion, underscoring the need for public education and workflow improvements to support earlier recognition and care.

Patients with branch retinal artery occlusion often experience delays in care. Most are not evaluated promptly by eye care providers, which may preclude timely diagnosis, stroke prevention, and potential future therapies.

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