A new study shows that only 8% of patients with a retinal infarction are seen by a neurologist even though they are at high risk for an ischemic stroke.
Furthermore, only about a third of these patients get brain imaging or receive heart rhythm monitoring, and less than a quarter undergo echocardiography.
“That’s really concerning,” study author Alexander E. Merkler, MD, assistant professor of neurology, Weill Cornell Medicine, Brain and Mind Research Institute, New York City, told Medscape Medical News.
“It’s telling us that we’re not evaluating risk factors for stroke in these patients, so we’re not doing a good job of preventing another stroke.”
The study was presented at last week’s International Stroke Conference (ISC) 2018 in Los Angeles.
The retrospective cohort study used inpatient and outpatient data from a nationally representative sample of 5% of Medicare beneficiaries over age 65 years from 2009 to 2015. Retinal infarction was documented by an ophthalmologist.
Primary outcomes within 90 days of the infarction were cervical carotid imaging, heart rhythm testing, echocardiography, and evaluation by a neurologist.
The researchers found that of 5688 Medicare patients with retinal infarction, only 34.1% (95% confidence interval [CI], 32.8% – 35.3%) had cervical carotid imaging, 28.6% (95% CI, 27.7% – 29.9%) had heart rhythm monitoring, and 23.3% (95% CI, 22.2% – 24.4%) had echocardiography.
Most patients with traditional stroke will get these tests, and most will also be seen by a neurologist. However, in this study, only 8.4% (95% CI, 7.7% – 9.2%) of those with retinal infarction were referred to a neurologist.
The problem is that “no one sort of follows up with these patients” to carry out evaluations, said Dr Merkler. “This needs to change.”
Results showed that the cumulative rate of ischemic stroke according to validated diagnostic codes was 1.0% (95% CI, 0.8% – 1.3%) at 90 days after retinal infarction. This, said Dr Merkler, is significantly higher than in the general population.
“We need to make sure that doctors are aware that if they diagnose someone with a retinal infarction, they need to refer that patient to a neurologist” or ensure that appropriate evaluations are carried out.
Neurologists also need to do a better job of “spreading the word” that patients who have a retinal infarction urgently need this type of care, said Dr Merkler.
He would like to see better communication between ophthalmologists and neurologists and agreed “100 percent” that a neurologist should be included on the medical care team.
REFERENCE: International Stroke Conference (ISC) 2018. Poster TMP 76. https://newsroom.heart.org/news/too-few-with-stroke-of-the-eye-are-treated-to-reduce-future-stroke?preview=5626