Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern®

RETINA/VITREOUS PREFERRED PRACTICE PATTERN® DEVELOPMENT PROCESS AND PARTICIPANTS

The Retina/Vitreous Preferred Practice Pattern® Panel members wrote the Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern® (PPP) guidelines. The PPP Panel members discussed and reviewed successive drafts of the document, meeting in person twice and conducting other review by e-mail discussion, to develop a consensus over the final version of the document.

Retina/Vitreous Preferred Practice Pattern Panel 2018–2019

Amani Fawzi, MD, Macula Society Representative

Gurunadh A.

FINANCIAL DISCLOSURES

In compliance with the Council of Medical Specialty Societies' Code for Interactions with Companies (available at www.cmss.org/codeforinteractions.aspx), relevant relationships with industry are listed. The Academy has Relationship with Industry Procedures to comply with the Code (available at http://one.aao.org/CE/PracticeGuidelines/PPP.aspx), A majority (88%) of the members of the Retina/Vitreous Preferred Practice Pattern Panel 2018–2019 had no financial relationship to disclose.

TABLE OF CONTENTS

• OBJECTIVES OF PREFERRED PRACTICE PATTERN GUIDELINES P265

• METHODS AND KEY TO RATINGS P266

• HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE P267

• INTRODUCTION P268

• Disease Definition P268

• Clinical Findings Characteristic of Retinal and Ophthalmic Artery Occlusion P268

• Patient Population P271

• Clinical Objectives P271

• BACKGROUND P271

• Incidence and Prevalence P271

• Risk Factors P272

• Natural History P272

• Rationale for Treatment P272

• CARE PROCESS P273

• Patient Outcome Criteria P273

• Diagnosis P274

  • History P275

OBJECTIVES OF PREFERRED PRACTICE PATTERN® GUIDELINES

As a service to its members and the public, the American Academy of Ophthalmology has developed a series of Preferred Practice Pattern® guidelines that identify characteristics and components of quality eye care. Appendix 1 describes the core criteria of quality eye care.

The Preferred Practice Pattern® guidelines are based on the best available scientific data as interpreted by panels of knowledgeable health professionals. In some instances, such as when results of carefully conducted clinical

METHODS AND KEY TO RATINGS

Preferred Practice Pattern® guidelines should be clinically relevant and specific enough to provide useful information to practitioners. Where evidence exists to support a recommendation for care, the recommendation should be given an explicit rating that shows the strength of evidence. To accomplish these aims, methods from the Scottish Intercollegiate Guideline Network¹ (SIGN) and the Grading of Recommendations Assessment, Development and Evaluation² (GRADE) group are used. GRADE is a

HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE

An ophthalmic artery occlusion (OAO), central retinal artery occlusion (CRAO), or, less commonly, a branch retinal artery occlusion (BRAO) can be associated with life-threatening conditions (e.g., carotid occlusive or cardiac valve disease). In patients over 50 years of age, one must additionally suspect giant cell arteritis (GCA) and should consider urgent systemic corticosteroid therapy when GCA is diagnosed or very likely in an attempt to preserve or recover vision in the affected eye and

INTRODUCTION

The arterial circulation to the eye involves many branches. Any one of these branches may have impaired flow that results from an obstruction. An embolus, defined as “a solid, liquid or gaseous mass carried by the blood to a site distant from its origin,” can occlude the vessel or lead to thrombus formation (i.e., a blood clot). Inflammation of a retinal vessel wall, or vasculitis, may also lead to an occlusion or thrombus formation. In general, an obstruction of either an ophthalmic or retinal

APPENDIX 1. QUALITY OF OPHTHALMIC CARE CORE CRITERIA

Providing quality care is the physician's foremost ethical obligation, and is the basis of public trust in physicians.

AMA Board of Trustees, 1986

Quality ophthalmic care is provided in a manner and with the skill that is consistent with the best interests of the patient. The discussion that follows characterizes the core elements of such care.

The ophthalmologist is first and foremost a physician. As such, the ophthalmologist demonstrates compassion and concern for the individual, and utilizes

APPENDIX 2. INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS (ICD) CODES

Retinal arterial occlusion, which include entities with the following ICD-10 classifications:

LITERATURE SEARCHES FOR THIS PPP

Literature searches of the PubMed and Cochrane databases were conducted in April 2018; the search strategies are provided at www.aao.org/ppp. Specific limited update searches were conducted after June 2019.

(retinal artery occlusion/pathology[majr] OR retinal artery occlusion/physiology[majr] OR retinal artery occlusion/physiopathology[majr])

(retinal artery occlusion/surgery[mh] OR retinal artery occlusion/therapy[mh] OR retinal artery occlusion/drug therapy[mh])

(retinal artery

RELATED ACADEMY MATERIALS

Basic and Clinical Science Course

Retina and Vitreous (Section 12, 2019–2020)

Focal Points

Retinal Arterial Occlusions (2010)

Patient Education

Face-Down Recovery After Retinal Surgery Brochure (2014)

Retina Informed Consent Video Collection (2013)

Preferred Practice Pattern® Guidelines – Free download available at www.aao.org/ppp.

Comprehensive Adult Medical Eye Evaluation (2015)

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