Eye stroke: It’s real, it’s frightening – and it’s reversible

Dr Akram Shhadeh [Photo: Denise Ritchie]

One of the most under-reported medical facts for seniors today is that human eyes – as well as the brain – can and do suffer strokes.

Cleveland Clinic Indian River Hospital’s Dr. Akram Shhadeh says 80,000 of the 795,000 strokes suffered in the U.S. annually are eye strokes. These potentially sight-stealing events occur when a blood clot restricts blood flow to the eye.

As the University of Pennsylvania Medical School explains, “an eye stroke, or anterior ischemic optic neuropathy, is a dangerous and potentially debilitating condition that occurs from a lack of sufficient blood flow to the tissues located in the front part of the optic nerve,” usually caused by a blood clot, and the faster that can be treated, the better the prognosis for recovering at least some sight.

The symptoms of eye stroke can vary and people who suffer one usually are given little warning. Most people with eye stroke notice a loss of vision in one eye upon waking in the morning but do not have any pain. Some people notice a dark area or shadow in their vision that affects the upper or lower half of their visual field. Other symptoms can include loss of visual contrast and light sensitivity.

But the most egregiously under-reported aspect of eye strokes is that they can be reversed … if you act fast.

Six hours is pretty much the outside limit between when a stroke occurs and when it is no longer reversible.

In a single week in April, three different patients came into Vero Beach’s New Vision Eye Center across the street from the hospital complaining of vision loss. Two of the three quickly found themselves on the other side of 37th Street in the hands of the hospital’s stroke team, while the third waited more than 48 hours before seeking treatment.

The two who sought immediate treatment regained much of their sight. The one who waited hasn’t.

While it’s understandable some people might think their eye doctor is the one to see if they experience vision loss, Shhadeh says the better move is to dial – or have someone else dial – 911.

“Patients should come into the emergency room … They should call 911 and be triaged as a stroke patient. When you are labeled with stroke diagnosis in the field that makes you come to us immediately without waiting in [the hospital] triage area. What’s more important, the whole stroke team is prepared when they get this notification ahead of time.”

New Vision Ophthalmologist Dr. David O’Brien and New Vision’s retinal specialist, Dr. Rob Reinauer, found and attempted to dislodge a clot in the first patient’s retinal artery but were unable to do so.

Knowing time was of the essence, O’Brien called the Cleveland Clinic emergency room and told them, “We’re sending this woman over now. Please expedite her.”

Then he notified her primary care physician.

His timely actions didn’t go unnoticed by Shhadeh. “I want to thank Dr. O’Brien,” Shhadeh says enthusiastically, “because he’s one of the few ophthalmologists I know [who] recognizes this as a treatable, reversible, disease. That’s part of the message we want to get out there to other eye doctors. This is a new treatment we have and it works.”

That treatment includes the injection of Tissue Plasminogen Activators, or tPAs, a drug that stimulates production of an enzyme that breaks down blood clots both in the eye and the brain.

And, if the thought of an injection into the eyeball causes you to cringe, it needn’t. The injection is actually done internally coming up by catheter from the femoral artery, through the arterial system and is injected from behind the eye. The patient doesn’t feel, see or even know it’s being done.

Like ischemic or hemorrhagic brain strokes, eye strokes provide little to no warning. O’Brien says he had “just seen [the first eye stroke patient] about two weeks prior to this event,” and there were no signs of trouble. Then with an audible sigh of relief he adds, “In my career of 25 years, I have never had anybody regain vision of a usable amount, a functional amount, with this problem. Until now.

“I want to praise Cleveland Clinic Indian River Hospital. I want to praise the emergency room staff and obviously the interventional neurology department, because without quick action, retinal tissue dies. Dr. Shhadeh called to let us know [the patient had recovered most of her eyesight] and I called him back and said, ‘You are a superstar. I have not seen this happen before. I’m very grateful.’”

It’s time that makes the difference. And the physicians and their tools.

According to the American Heart Association, “most patients who suffer a stroke in the eye don’t get a follow-up evaluation that could help prevent them from later having a traditional – and potentially deadly – stroke in the brain,” but Shhadeh says that at Cleveland Clinic, “we know exactly what caused their symptoms and they’re now on the right treatment for their risk factors.”

Shhadeh concludes by offering some urgent advice about strokes in general: “I want to emphasize the ‘BE FAST’ acronym, where B stands for balance, E stands for eye vision, F stands for facial weakness, A stands for arm or leg weakness, S for speech – slurred speech or inability to produce or understand speech – and T stands for time to call 911.”

But even without the B, F, A or S, if you experience vision loss, call 911. It could save your sight.

Dr. Akram Shhadeh is with the Cleveland Clinic Indian River Hospital’s Arubah Neuroscience stroke team. He has written a book called “FAST Stroke Guide” which is now available at Amazon.com. While its primary intended audience is healthcare providers, Shhadeh says “it is written in a very simple and clear manner without compromising scientific content.” Shhadeh’s offices are at 3450 11th Court in Vero Beach. Dr. David O’Brien is with New Vision Eye Center at 1055 37th Place also in Vero Beach.

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