Frequency and characteristics of central retinal artery occlusion

The occlusion of the central retinal artery is estimated at 2.2 per 100,000 inhabitants.
Patients diagnosed with CRAO have a life expectancy of 5.5 years compared to 15.4 years for age-matched non-CRAO patients.
Patients with CRAO often present with a unilateral loss of light perception. However, visual acuity can vary from loss of light perception to counting fingers. An immediate examination by an ophthalmologist must be carried out. At the fundus, the retina appears diffusely pale with a cherry-red central spot.

Treatments

The goal of treatment is to immediately restore retinal circulation.
Practical use of HBOT

• 2000: With HBOT, 8 patients experienced an average increase of 2 lines, 3 of 8 patients experienced an increase of 2 lines or more, and 5 of 8 patients had no change in VA.
• 2002: HBOT achieved subjective improvement in 19 of 21 patients with CRAO. Improvement was confirmed in 13 patients.
• 2009: HBOT improved the vision of 2 patients 24 hours after their vision loss.
• 2016: HBOT is an effective treatment for non-arteritic CRAO if a cherry red spot has not formed in the retina.
• 2017: HBOT significantly improved vision loss in 2 cases. In one case the improvement was demonstrated using fluorescein angiography.
• 2018: In a survey of 45 hospitals in the US on the treatment of central retinal artery occlusion, only 3 offered HBOT as initial treatment, 30 offered eye massage, 19 anterior chamber paracentesis, 4 no treatment. In 17 hospitals the patient was not referred to the emergency department.
• 2019: Our results are similar to other case studies with approximately 65-70% improvement in patients treated with HBOT for CRAO.
• 2019: HBOT leads to vision improvement in patients with RAO when performed early. It appears to be an effective and safe therapeutic option for a pathology for which there is still no approved treatment.
• 2020: HBOT group shows significant improvement in visual acuity than the group without HBOT.
• 2020: HBOT appears to have a positive effect on visual outcomes in patients with retinal branch artery occlusion.
• 2020: Diabetics who should be treated with HBOT for central retinal artery occlusion, further observed to rule out retinal neovascularization.
• 2021 HBOT is classified at Level IIb by the American Heart Association for CRAO.
• 2021: Our results suggest that HBOT has a protective effect against retinal neovascularization and may improve visual acuity in the long term.
• 2022: Using HBOT as part of standard treatment for CRAO improves the final visual outcome. HBOT is safe and can be implemented in all tertiary medical centers when available.
• 2022: HBOT does not seem to improve the final visual result.
• 2023: An average improvement in visual acuity of 0.5 logMAR (p=0.01) was observed when patients received HBOT sooner than 24 hours after symptom onset. This mean improvement increased to 0.9 logMAR (p=0.009) when HBOT was initiated within eight hours.
• 2023: HBOT was approved in 2006 to treat central retinal artery occlusion. It remains an underutilized modality, due in part to a lack of availability and knowledge in the ophthalmology community.
• 2023: Thirty-one patients were enrolled and received an average of 33.9 (13-56) HBOT sessions twice per day. Longer HBOT allows revascularization of the damaged retina.

• 2024: HBOT improved an unexpected blindness as a result of cosmetic filling of her nasolabial folds.

Practical use of HBOT

Most of the time it is treated intensively, 2-3 times per day; more recent studies treat it until the new vessels have formed in the retina.