From the Guidelines
After diagnosis of ocular ischemic syndrome (OIS), a comprehensive cardiovascular evaluation is essential, prioritizing carotid artery imaging with duplex ultrasonography, followed by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA) to assess the cerebrovascular system, as recommended by the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline 1. The evaluation should focus on identifying significant carotid artery disease, which is a common underlying cause of OIS.
- Carotid duplex ultrasonography is the initial imaging modality of choice to detect carotid stenosis, as it is non-invasive and can provide valuable information on the degree of stenosis 1.
- If the results of duplex ultrasonography are equivocal or indeterminate, CTA or MRA can be useful to evaluate the severity of stenosis and identify intrathoracic or intracranial vascular lesions 1. Additional cardiovascular assessment should include:
- A 12-lead electrocardiogram to evaluate cardiac function and potential sources of emboli
- Echocardiography to assess cardiac function and potential sources of emboli, as recommended by the 2021 American Heart Association scientific statement on the management of central retinal artery occlusion 1
- Blood pressure monitoring to assess for hypertension, a common risk factor for cardiovascular disease
- Laboratory tests to assess lipid profile, blood glucose, hemoglobin A1c, and inflammatory markers, which can help identify underlying cardiovascular risk factors. Consultation with a vascular surgeon or interventional radiologist is recommended to discuss potential revascularization procedures, such as carotid endarterectomy or stenting, if significant stenosis (typically >70%) is identified 1. This thorough evaluation is crucial because OIS patients have a high risk of stroke and cardiovascular mortality, and early identification and management of underlying cardiovascular disease can significantly improve both ocular outcomes and overall survival.
From the Research
Cardiovascular Evaluation after Diagnosis of Ocular Ischemic Syndrome
The diagnosis of ocular ischemic syndrome (OIS) necessitates a comprehensive cardiovascular evaluation due to its association with carotid artery stenosis and atherosclerosis 2.
Key Components of Cardiovascular Evaluation
- Carotid artery imaging, including Doppler scans, to assess the degree of stenosis and guide further management 3
- Fundus fluorescein angiography to evaluate retinal perfusion and detect signs of ischemia 2
- Systemic evaluation for atherosclerotic disease, considering the high prevalence of cardiovascular risk factors in patients with OIS 4
Role of Carotid Revascularization
- Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are treatment options for patients with significant carotid stenosis, aiming to improve ocular and cerebral perfusion 5, 6, 4
- Early intervention is crucial to prevent progressive visual loss and reduce the risk of cerebrovascular events 4
Multidisciplinary Approach
- Collaboration between ophthalmologists, vascular surgeons, and cardiologists is essential for the timely diagnosis and management of OIS, ensuring optimal outcomes for patients 2, 4
- A comprehensive approach includes not only local ocular treatment but also systemic management of cardiovascular risk factors and carotid artery disease 2