Nonmydriatic fundus photography after suspected minor stroke or transient ischemic attack was able to differentiate between actual stroke and mimics, according to findings from the FOTO-ED TIA study presented at the International Stroke Conference.
Any retinal microvascular finding assessed with nonmydriatic fundus photography after suspected minor stroke or TIA, which can be done by nonophthalmic experts and requires no pupillary dilation, was linked to a 15.6% (95% CI, 4.2-27.1) increase in cerebrovascular event probability.
Moreover, after excluding patients with lesions confirmed by diffusion-weighted MRI, the discovery of at least one retinal microvascular finding conferred a 21.8% (95% CI, 6.1-37.5) increase in cerebrovascular event probability.
“Retinal microvascular findings assessed by the nonmydriatic ocular fundus photographs during the evaluation of suspected TIAs are an independent factor in differentiating TIA and strokes from mimics,” Fadi B. Nahab, MD, associate professor of neurology and pediatrics and medical director of the stroke program at Emory University Hospital at Emory University Hospital Midtown, said during a presentation. “Retinal microvascular findings provide a novel diagnostic test for TIA, which in reality remains a diagnosis based on expert opinion.”
For this study, researchers assessed patients with suspected TIA (median age, 57 years; 55% women; 64% black; 9% with at least one retinal microvascular finding) with nonmydriatic ocular fundus photographs with the aim of identifying those with actual TIA or stroke.
Retinal microvascular findings included retinal embolisms, retinal occlusions, focal arteriolar narrowing, optic disc pallor, hard exudates, arteriovenous nicking, microaneurysms, cotton wool spots and retinal hemorrhages.
“In the era of artificial intelligence, the main intent moving forward is to use AI to basically provide these automated readings of these fundus photographs in a means of providing these results in real time to ED physicians who can better prioritize patients and assess patients for whether they’ve had a cerebral vascular event or not,” Nahab said during the presentation. – by Scott Buzby
Nahab FB, et al. LB6. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.
Disclosures: The authors report no relevant financial disclosures.