When a patient shows up in the emergency department with sudden vision loss, every minute counts.
Central retinal arterial occlusion (CRAO) is a stroke in the eye, which manifests with acute vision loss. Like other types of stroke, the window to administer clot-busting treatment to try to prevent permanent, severe visual impairment is only 4.5 hours.
In 2022, Dr. Molly Burnett, neurologist at KP San Francisco and director and chief of teleneurology at TPMG; Dr. Aubrey Gilbert, neuro-ophthalmologist at KP Napa-Solano; Dr. Dana Sax, emergency medicine physician at KP East Bay; and Dr. Robin Vora, retina specialist at KP East Bay and chair of ophthalmology at TPMG, formed a partnership to rapidly evaluate and manage patients who arrive at KP Northern California emergency rooms with sudden vision loss.
All KP emergency departments now activate a treatment pathway to take high-resolution pictures of the back of the eyes with a stationary fundus camera. If the on-call ophthalmologist confirms CRAO, the KP Northern California Telestroke system is activated, allowing the on-call vascular neurologist to evaluate the patient rapidly by video with concurrent neurovascular imaging. Shared decision-making is then undertaken with the patient to pursue intravenous fibrinolytic therapy, which can dissolve clots and restore blood flow to the eyes.
The fundus cameras are now in place in all 21 emergency departments across KP Northern California, helping to expedite patient care. While only about 17% of patients with untreated CRAO regain functional vision, KP patients receiving intravenous fibrinolytic therapy have had better visual outcomes: they are nearly twice as likely to experience improvement, and more than five times less likely to worsen compared with untreated patients.
“This team of visionary physicians has successfully designed and operationalized a groundbreaking pathway, which aligns stroke neurology and ophthalmology in a way that is life altering for patients,” says Dr. Monica Kendrick, physician in chief at KP San Francisco.