To report a novel protocol for diagnosis of retinal artery occlusions at the point of care using OCT and a remote consult model. Retrospective case series and evaluation of a diagnostic test or technology. Adult patients who presented with painless monocular vision loss and were diagnosed with a nonarteritic retinal artery occlusion. OCT machines were placed in the stroke center or emergency department at 3 hospitals within our health system. Patients who presented with painless monocular vision loss were evaluated by the stroke neurology service and an OCT was acquired. The images were interpreted remotely by the retina service. An in-house ophthalmology consult was not required to make the final treatment decision. Eligible patients were treated with intra-arterial tissue plasminogen activator (IA-tPA). Patients were followed by ophthalmology during their admission when an in-house consultation service was available or otherwise evaluated immediately after discharge. Visual acuity (VA) before and after treatment with IA-tPA; time from last known well (LKW) to treatment; and time from presentation to treatment. In the first 18 months since the protocol went live, 59 patients were evaluated. Twenty-five patients (42%) had a confirmed retinal artery occlusion based on OCT and follow-up examination. Ten patients were eligible for treatment, and 9 patients received treatment with IA-tPA. There was a statistically significant improvement in mean VA from logarithm of the minimum angle of resolution (logMAR) 2.14 to logMAR 0.7 within 24 hours after treatment ( 0.0001) and logMAR 1.04 after 4 weeks ( 0.01). Clinically significant improvement was noted in 66% of patients within 24 hours and maintained through 1 month in 56% of all treated patients. The mean time to treatment from LKW was 543 minutes and from presentation at the stroke center was 146 minutes. We report the successful implementation of a remote consult protocol using point-of-care automated OCT. This novel paradigm demonstrates the potential utility of remote consult services for the diagnosis of time-sensitive ophthalmic emergencies. Proprietary or commercial disclosure may be found after the references.

中文翻译：

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远程会诊视网膜动脉阻塞诊断协议

报告一种使用 OCT 和远程会诊模型在护理点诊断视网膜动脉闭塞的新方案。回顾性病例系列和诊断测试或技术的评估。表现为无痛性单眼视力丧失并被诊断为非动脉炎性视网膜动脉闭塞的成年患者。OCT 机器被放置在我们卫生系统内 3 家医院的中风中心或急诊科。中风神经病学服务部门对出现无痛性单眼视力丧失的患者进行了评估，并进行了 OCT 检查。这些图像由视网膜服务远程解释。做出最终治疗决定不需要内部眼科咨询。符合条件的患者接受动脉内组织纤溶酶原激活剂（IA-tPA）治疗。当有内部咨询服务时，患者在入院期间接受眼科随访，或在出院后立即进行其他评估。IA-tPA治疗前后的视力（VA）；从最后已知井 (LKW) 到治疗的时间；以及从就诊到治疗的时间。该方案实施后的前 18 个月内，对 59 名患者进行了评估。根据 OCT 和随访检查，25 名患者 (42%) 确诊为视网膜动脉闭塞。10 名患者符合治疗条件，9 名患者接受 IA-tPA 治疗。治疗后 24 小时内，平均 VA 从最小分辨率 (logMAR) 的对数 (logMAR) 2.14 提高到 logMAR 0.7 (0.0001)，并在 4 周后提高到 logMAR 1.04 (0.01)。66% 的患者在 24 小时内出现临床显着改善，并且在所有接受治疗的患者中，56% 的患者持续 1 个月。从 LKW 到接受治疗的平均时间为 543 分钟，从到中风中心就诊的平均时间为 146 分钟。我们报告使用床旁自动 OCT 成功实施远程咨询协议。这种新颖的范例证明了远程咨询服务在诊断时间敏感的眼科紧急情况方面的潜在效用。专有或商业披露可以在参考文献之后找到。