Real-world acute retinal artery occlusion (RAO) management didn’t live up to recent American Academy of Ophthalmology (AAO) recommendations, a paper published online as part of ARVO’s 2020 collection suggests.

The study analyzed 9,300 new outpatient diagnoses between 2004 and 2016 of either branch RAO (BRAO) or central RAO (CRAO). The researchers reviewed claims to identify key diagnostic tests specified by the AAO as recommended components of an RAO work-up, including a carotid ultrasound, an echocardiogram, magnetic resonance imaging (MRI) and an emergency department (ED) referral.

The researchers found that 14.8% of patients received a carotid ultrasound within seven days and 27.8% within 30 days post-diagnosis. As for an echocardiogram, they discovered that only 7.6% of patients underwent screening within seven days and 18.4% within 30 days. They noted that patients with CRAO, male gender, younger age, white race and upper Midwest location were significantly most likely to receive both a carotid ultrasound and an echocardiogram within seven days.

The team reported that 2.8% of patients received an MRI within seven days and 5.7% within 30 days. They added that patients with CRAO and upper Midwest location were most likely to receive an MRI within seven days. They saw that 1.7% of patients were referred to the ED on the day of or day after diagnosis, with younger age being associated with a significantly increased likelihood of a ED referral.

When it came to diagnosing provider, the investigators found that ophthalmologists diagnosed the majority (88.1%) of RAOs compared with neurologists (0.3%) and others (11.5%). Compared with “other” doctors, they noted that patients diagnosed by ophthalmologists were significantly more likely to have a carotid ultrasound within seven days but less likely to have an echocardiogram, MRI or emergency room referral.

The study authors concluded that the rates for each of the AAO guidelines for RAO care increased significantly between 2004 and 2016.