Visual outcomes of branch retinal artery occlusions effected by early detection

Visual outcomes in patients who have experienced branch retinal artery occlusions are predicated by the level of vision at the time of presentation.

"The good news for patients with BRAO and a visual acuity of 20/40 or better is that they are likely to retain that good vision," said Peter Gehlbach, MD, PhD, associate professor of vitreoretinal surgery in the Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine.

BRVO is even more common than blockage of a branch retinal artery.

To illustrate these conclusions, Dr. Gehlbach presented a few cases to audience members at the third annual Evidence Based Care in Myopia Control, Retina, and Vision Enhancement meeting of The Wilmer Eye Institute, held in conjunction with the Maryland Optometric Association.

Presentation and prognosis

Patients with BRAO will typically present with acute, unilateral, painless, partial visual loss, with visual field defects that can be central or sectoral, Dr. Gehlbach said. These patients may even be asymptomatic. Risk factors for BRAO include smoking, hypertension, hypercholesterolemia, diabetes, coronary artery disease, and a history of stroke or transient ischemic attack.

Visual prognosis after BRAO seems to be correlated with presenting visual acuity. Eyes with an initial acuity of 20/40 or better usually remained at 20/40 or better, according to a study by Mason et al.1 In the same study, however, patients with a visual acuity of 20/100 or worse generally did not show significant improvement in vision, also supporting prior studies in this area.

BRAO and heart disease

To illustrate in application, Dr. Gehlbach related the case of a 57-year-old African American male who presented with sudden onset of a blurred area in the right eye. This patient was hypertensive and smoked. At presentation, his vision was 20/30. Fundus examination and fluorescein angiography confirmed BRAO.

The patient was referred to his internist for cardiovascular evaluation and management of cardiovascular risk factors. The internist called to inquire as to the association of BRAO and heart disease, and to determine if the patient should expect further loss of vision. Following discussion, the internist fully evaluated the patient and discovered significant cardiovascular disease. Antihypertensive therapy was instituted.

The patient was relieved to learn that, while not likely to clear, his vision loss was likely to remain stable. He volunteered that he had quit smoking after learning of the potential association between smoking and his vision.