Ocular Arterial Occlusive Disorders and Carotid Artery Disease

Abstract

Objective To compare prevalence of carotid artery disease and its various types of lesions in different types of ocular arterial occlusive disorders. Design Cohort study. Subjects We included 614 consecutive patients (728 eyes) with ocular arterial occlusive disorders. Methods At first visit, all patients had a detailed ophthalmic and medical history, comprehensive ophthalmic evaluation, and carotid artery evaluation (by Doppler/angiography) on the side of ocular arterial occlusion, and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit. Ocular arterial occlusive disorders were divided into central (CRAO) and branch (BRAO) retinal artery occlusion, ocular ischemic syndrome (OIS), nonarteritic anterior ischemic optic neuropathy (NA-AION) and amaurosis fugax (AF). Main Outcome Measures Carotid artery and echocardiographic abnormalities, and incidence of transient ischemic attack (TIA)/stroke and myocardial ischemia. Results The study consists of a cohort of 266 eyes with NA-AION, 203 with CRAO, 127 with BRAO, 80 with OIS, and 52 with AF. Carotid artery stenosis on the involved side was worse in AF and OIS compared with BRAO, CRAO, and NA-AION (P < 0.0001). The presence of carotid artery plaques on the involved side was significantly higher in OIS, AF, and CRAO compared with NA-AION (P = 0.002, P = 0.003, and P = 0.0003, respectively). Echocardiography revealed an embolic source in 61% of CRAO and 53% of BRAO compared with only 3% of NA-AION patients (P < 0.0001). Stroke or TIA before or after the onset of ocular condition occurred in 17% of OIS, 11% of AF, 7% of CRAO, 6% of NA-AION, and 3% of BRAO patients. Kaplan-Meier estimate of the incidence of TIA/stroke within 3 months after onset was 6% (95% confidence interval, 2%–17%) for OIS, 3% (95% confidence interval, 0.4%–19%) for AF, and 1% (95% confidence interval, 0.3%–4.1%) for CRAO. A report of myocardial ischemia before or after the onset of an ocular condition was 52% in AF, 22% in OIS, 22% in BRAO, 21% in CRAO, and 6% in NA-AION patients. Conclusions The incidence of carotid artery stenosis and plaques, cardiac embolic source, TIA/stroke, and myocardial ischemia differ among various ocular arterial occlusive disorders. The role of embolism and hemodynamic disturbances caused by carotid artery disease in these disorders is discussed.