Eye Exam Saves Life!

Patients with a retinal artery occlusion can be at great risk for having a heart attack and/or stroke. Just as the artery in the eye gets blocked, so too can an artery in the brain or heart. Assessing the heart and major arteries for disease can prevent this from occurring.

Artery Gets Blocked

Blood leaves the heart via the aorta and then enters the carotid arteries (large vessels that send blood to your head). The central retinal artery supplies all the blood to the retina.

In both a central retinal artery occlusion (CRAO) and a branch retinal artery occlusion (BRAO), the blood vessels becomes blocked, blood flow is stopped and permanent vision loss can occur.

Vision Loss

Vision loss is usually sudden and painless.  It can be complete and permanent.  Sometimes the blockage is temporary and vision is restored after 15-20 minutes.  This phenomenon is called “amaurosis fugax.”

Partial loss of sight may occur from a branch artery occlusion where a small portion of the retinal circulation is blocked.

Retinal Artery Occlusions

Branch Retinal Artery Occlusion

Sources of Blockage

The usual culprit in retinal occlusions is a small piece of cholesterol from the carotid arteries. The actual blockage can be seen when looking directly at the retina.  This is best done by having your pupils dilated.  A flourescein angiogram may be helpful, too.

Other causes include blood clots or high levels of fats in your blood.

What Your Doctor Needs to Do

Nothing can be done for your vision when an artery occlusion occurs. Your doctor needs to be on the look out for neovascularization to occur somewhere in your eye. This could cause a painful type of glaucoma.  Neovascular glaucoma can be prevented.

Most importantly, your doctor needs to order tests looking for the source of the clots or plaque. This usually entails evaluation of the heart with an echocardiogram and an ultrasound of the carotid arteries. Other tests may be needed.

Patients at Risk

Patients with diabetes and high blood pressure are at greater risk for these conditions. Also, atrial fibrillation (heart rhythm disorder) and disorders with high blood fats can cause artery occlusions.

What Does This Mean? This is one of the few instances where your eye doctor could literally save your life. While there is really nothing we can do to improve your vision, we can make sure that you are not at risk for a heart attack or stroke.

Sudden painless loss of vision should be evaluated even if your vision returns to normal.  While there are other causes of these symptoms, you should be evaluated for systemic disease.

Even if you are not diabetic or do not have high blood pressure, make sure to alert your doctor.

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Comments

  1. it’s amazing what a simple eye exam could do for you.

    Thanks for informing everyone.

    Best,
    Monterey Park Optometry
    http://www.mpocares.com/comprehensive-eye-exams/

  2. Nancy Lindsey says:

    My 88 year old mother lost most of the vision in her right eye suddenly. She was told to go to the ER where she was diagnosed with blocked carotid arteries. One 80% and one 50%. She was seen by a vascular doctor who said he thought she should be seen by a retinal specialist. He arranged the appointment the following day. It was determined that she had a blocked retinal artery and most of her sight was gone in that eye. It was then strongly suggested that she have a Temporal Artery Biopsy to determine if she had GCA. We agreed but now that we have read about it we don’t feel like it is necessary since she doesn’t have any of the symptoms except an elevated sed rate due to a low white blood count. We feel that she is more a candidate for carotid artery surgery to open the arteries. What do you think?

  3. Dear Nancy,

    If memory serves me correctly, the blockage of the arteries may not be too significant? Perhaps this changes because of the artery occlusion.

    Not sure I understand why the biopsy is needed either. Does someone feel this more is more than a blocked artery?

    Randy

  4. Hello :} I’m 48 yrs old and was discharged from the hospital (where I also work – talk about being in the right place at the right time) last night after being diagnosed with BRAO. Sudden onset loss of vision in the first hour of my shift as a patient transporter. I have probably a 35% vision loss in the lower left quadrant of my right eye. Was hospitalized 3 days and had every test under the sun…..and a slew of bloodwork. 8.4 hgb, 600k+ platelets. A lot of esoteric tests were ordered and will take a while to come back. I’ve come to grips with the vision loss. Quite a weird thing to adjust to, I’m more concerned with the bloodwork I’m waiting on, but I wonder….after doing what I should never have done- Googled this BRAO thing – given my age, how often does a follow up occlusion happen, and if so, how long between incidents? I guess the scary part is that I didn’t feel anything more than a little dizzy, then loss of vision. No pain. No precursor. No warning. I’ve had a CVA ( bleeder ) in the past. Maybe 10 yrs ago. That was a totally different situation…..intense headache, sky high HP. This BRAO was a totally different animal. Just wondered if I should be expecting something else! Kinda like walking on eggshells. I havent gone for any follow up visits yet ( primary, cardio, hematologist, neuro & ophthalmologist are all scheduled over then next couple weeks, TEE to be scheduled). I guess my question isnt so much a technical one, but a comparison to other cases?

    Thanks Doc, for making this blog available to us laypeople. You really put a human side to the medical professionals.

    Thanks again!
    karen/nj

  5. Dear karen g,

    Wow! Tough case.

    In my experience, most BRAO’s are caused by plaque and don’t recur very often.

    There are, however, other causes of BRAO; platelets, blood clots, fat. In these latter causes, I’d be more fearful of a system problem.

    Randy

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