Talk:Central retinal artery occlusion

Photograph?

If anyone has a photograph (fair use) of the cherry red spot, that would be great! Rytyho usa (talk) 03:06, 2 February 2014 (UTC)

Queen's University Student Editing Initiative

Hello, we are a group of medical student’s from Queen’s University. We are working to improve this article over the next month and will posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. 14tcm1 (talk) 20:19, 11 November 2019 (UTC)

Here are my proposed changes for the addition of a diagnosis section:

One diagnostic method for CROA is Fluorescein angiography, to examine the choroidal filling time. In a healthy eye the choroidal filling is complete within 5 seconds of the dye first appearing in the eye, if this time is prolonged it may be caused by CRAO. Fluorescein angiography can also be used to determine the extent of the occlusion as well as classify it into one of four types non-arteritic CRAO, non-arteritic CRAO with cilioretinal artery sparing, transient non-arteritic CRAO and arteritic CRAO.[1]

Recently, two new non-invasive imaging techniques have emerged that aid in the diagnosis of central retinal artery occlusion: Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA). Patients may have anatomic differences in the different layers or blood vessels of the eye, which can be visualized with these imaging techniques.

• a picture of fluorescein angiography provided by Dr. Sanjay Sharma will also be included in this change

14tcm1 (talk) 17:41, 18 November 2019 (UTC)

Thank you for sharing these proposed article improvements. For adding your image, please have Dr. Sharma add it to directly to commons and then you can share the link here on the article talk page. http://commons.wikimedia.org/wiki/Special:UploadWizard JenOttawa (talk) 18:23, 18 November 2019 (UTC)

Prognosis and diagnosis section:

Change 1: The incidence of CRAO is approximately 1 in 100,000 people in the general population.

Change 2:"Irreversible damage to neural tissue occurs after only 90 minutes" --> change to --> "Irreversible damage to neural tissue can occur after 12-15 minutes of complete blockage of the central retinal artery, but this time may vary between individuals."

Change 3: "Risk factors for CRAO include the following: being between 60 and 65 years of age, being over the age of 40, male gender, hypertension, caucasian, smoking and diabetes mellitus." --> change to --> "Risk factors for CRAO include the following: being over 50 years of age, male gender, smoking, hypertension, diabetes mellitus, dyslipidemia, angina, valvular disease, transient hemiparesis, cancer, hypercoagulable blood conditions, or a family history of cerebrovascular or cardiovascular issues."

References

User:14hgl1

Proposed change for treatment:

Several treatments have been attempted for CRAO, however, none show definitive improvement in outcomes. Current therapeutic modalities of CRAO include the following:

• Lowering intraocular pressure;
• Dilating the CRA;
• Increasing oxygenation;
• Isovolemic hemodilution;
• Anticoagulation;
• Dislodging or fragmenting thrombus or embolus; and,
• Other therapy: Hyperbaric oxygen.

To achieve the best outcome for the person with CRAO, it is primordial to identify the condition in a timely manner and to refer to the appropriate specialist.

References

18j03 (talk) 01:18, 19 November 2019 (UTC)

Thank you for sharing these. @18j03: for your sentence, "Several treatments have been attempted for CRAO, however, none show definitive improvement in outcomes. Current therapeutic modalities of CRAO include the following" I added a citation needed tag. You can re-use the same reference more than once, but on Wikipedia we need to repeat the citations after most sentences in case your paragraph (or section) gets truncated by another editor in the future. If you have any questions please let me know. JenOttawa (talk) 01:25, 19 November 2019 (UTC)

Proposed Changes for the Mechanism section: 1) Remove reference used in existing sentences, and use this reference instead. Rationale for proposed change: The citation does not lead to a reference, the new reference states the same understanding of the central retinal artery anatomy and course. There may be disagreement whether to keep the same material with a new reference however this is widely accepted anatomy and therefore I believe it is acceptable to just provide the new reliable reference.

2) Additional sentences to add following the last sentence of "Mechanism" section: Central retinal artery occlusion is most often due to emboli blocking the artery and therefore prevents the artery from delivering nutrients to most of the retina. These emboli originate from the carotid arteries most of the time but in 25% of cases, this is due to plaque build-up in the ophthalmic artery. The most frequent site of blockage is at the most narrow part of the artery which is where the artery pierces the dura covering the optic nerve. . Rationale for proposed change: Though other sections of the article contribute some insight to understanding this component of central retinal artery occlusion, a gap in information was noticed between the discussion of the artery's anatomy and the causes of its occlusion by emboli. These sentences would serve to connect these discussions and provide a more complete picture. There may be variation in the opinion of the frequency that emboli originate within the artery itself but the stated 25% rate will be supported with reliable evidence.

References

Oginty (talk • contribs) 02:24, 19 November 2019 (UTC)

Thank you for sharing these proposed improvements @Oginty: I noted above about having Dr. Sharma add his images to Wikipedia commons and then you can share links here on the talk page. That is great that we have some new images to share! Your class is going a great job! This article gets viewed at least 100xs per day (see this tool). It will be interesting to see if this increases once we have some new images and these improvements. Thank you again! JenOttawa (talk) 02:32, 19 November 2019 (UTC)

18mlk7 (talk) 02:47, 19 November 2019 (UTC) Proposed changes for signs and symptoms section: "Central retinal artery occlusion is characterized by painless, acute vision loss in one eye. Upon fundoscopic exam, one would expect to find: cherry-red spot (Figure X) (90%), retinal opacity in the posterior pole (Figure Y) (58%), pallor (39%), retinal arterial attenuation (32%), and optic disk edema (22%). During later stages of onset, one may also find plaques, emboli, and optic atrophy."

This section will include an example figure for the cherry-red spot and retinal opacity in the posterior pole (the two most commonly seen signs) were included due to their prevalence. The retinal opacity of the posterior pole was also not able to be hyperlinked to an existing page for clarity (as it is a more visual phenomenon) thus an image would be the most effective way to explain this sign.

References

Thanks for sharing this. Please see above comments re: Wikipedia Commons for the images. JenOttawa (talk) 02:50, 19 November 2019 (UTC)

Proposed changes for Causes section:

"Causes of CRAO may be examined based on its various classifications, including non-arteritic and arteritic CRAO. Non-arteritic CRAO is most commonly caused by an embolus and occlusion at the narrowest part of the carotid retinal artery due to plaques in the carotid artery resulting in carotid retinal artery atherosclerosis. Further causes of non-arteritic CRAO may include vasculitis and chronic systemic autoimmune diseases. Arteritic CRAO is most commonly caused by giant cell arteritis."

Rationale for proposed changes: First sentence: the aim of this sentence was to introduce readers to the existence of and distinction between various subclassifications of CRAO, and how different classifications have different causes. The previous version of the article did not introduce such classifications, and was not specific as to which type of CRAO can be attributable to which cause. The organization of CRAO into subclassifications was consistent across all three cited sources, therefore I believe its inclusion is justified. Second sentence: while the aim of the original sentence of how carotid artery atherosclerosis is a common cause of CRAO was maintained, this sentence was expanded on to explain how atherosclerosis can lead to the formation of an embolus in non-arteritic CRAO specifically, which was brought up by all three cited authors. Third sentence: this sentence was added to include additional causes of non-arteritic CRAO other than embolus. These additional causes are supported by both Dr. Sanjay Sharma and Dr. Sohan Hayreh, a leading expert in this field. Fourth sentence: this sentence was modified to remove the age of 70 years old as a risk factor for giant cell arteritis, as information regarding which age group this complication was most prevalent in varied in the literature, and no one age was found to be definite. The sentence was restructured to emphasize the main point of giant cell arteritis being the main cause of arteritic CRAO, as evidenced by consistent information across all three sources.

14AJ55 (talk) 03:14, 19 November 2019 (UTC)