This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on ISI (9)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Neurology  • Cardiovascular System  • Cardiovascular System, Other  • Alert me on articles by topic

Sanjay Sharma, MD, MSc(Epid); Gary C. Brown, MD, MBA; Joe L. Pater, MD, MSc(Epid); Alan F. Cruess, MD

Arch Ophthalmol. 1998;116:1602-1606.

Objective  To determine the value of visible retinal emboli as a diagnostic "test" for the detection of hemodynamically significant carotid artery stenosis in the setting of acute retinal artery occlusion.

Methods  A cross-sectional diagnostic accuracy study was performed in a tertiary North American center, with the results of the dichotomous diagnostic test (the presence or absence of visible retinal emboli) being placed against the dichotomous outcome of the presence or absence of hemodynamically significant carotid artery stenosis (defined as 60%, or <60%, carotid artery stenosis on either side).

Results  Forty-eight (18.7%) of our 256 patients had hemodynamically significant carotid artery stenosis. The sensitivity and specificity of retinal emboli for the detection of hemodynamically significant carotid artery stenosis were 39% and 68%, respectively. The presence of a visible retinal embolus generated a likelihood ratio of 1.24 (95% confidence interval, 0.84-1.86). This value corresponds to a patient with a pretest probability of 50% having a posttest probability of 55.3%. The absence of a visible retinal embolus generated a likelihood ratio of 0.88 (95% confidence interval, 0.68-1.15).

Conclusions  The presence of a visible retinal embolus is a poor diagnostic test for the detection of hemodynamically significant carotid artery stenosis in the setting of acute retinal artery occlusion. Accordingly, the presence of an embolus should not influence the decision to perform carotid Doppler ultrasonography in patients with acute retinal arterial occlusion.

From the Departments of Ophthalmology (Drs Sharma and Cruess) and Epidemiology (Drs Sharma, Pater, and Cruess), Queen's University, Kingston, Ontario; and Retina Service, Wills Eye Hospital, Philadelphia, Pa (Drs Sharma and Brown).