Duke Emergency Services for Eye Stroke Have Regional Reach

Patients with sudden and painless loss of vision may benefit from transfer to specialized facility

Brian C. Mac Grory, MB BCh BAO, MRCP, is a vascular neurologist at Duke Health. Along with colleagues in Duke Ophthalmology, he has set up a treatment program for patients with eye stroke. He recently discussed this vision-threatening disorder, which is associated with an increased risk of brain stroke.
What are the signs of an eye stroke?

The main symptom is sudden, painless, vision loss or darkening in one eye.
How is it diagnosed?

Eye stroke is diagnosed by taking a history and performing a funduscopic examination of the back of a person’s eye. The other conditions to be considered in the differential diagnosis include retinal detachment, intraocular hemorrhage, and ischemic optic neuropathy. A specialized imaging tool such as optical coherence tomography (OCT) can help confirm the diagnosis and track the amount of damage to the eye but is not strictly necessary to make the diagnosis.
Does Duke offer treatment resources that set it apart?
In addition to tissue plasminogen activator, Duke offers hyperbaric oxygen therapy. Our hyperbaric chamber program is one of the country’s largest, the only civilian facility certified by the U.S. Navy, and one of the few in the Southeast that operates 24/7. It is fully staffed by physicians certified in hyperbaric medicine.

When and how should a physician refer an eye stroke patient?

Any patient with a suspected eye stroke should call 911 or go to the nearest emergency department. A physician treating such a patient should call the Duke transfer center at 919-681-3440 to transfer them to Duke.

Can sudden blindness be reversed?
The faster patients receive care for an eye stroke, the more likely they will have a positive outcome. In certain patients, treatment within 4.5 hours of symptom onset may be able to improve the symptoms of an eye stroke. However, this is an emerging area of science, and we are working on pioneering the tools needed to effectively treat it.

How does the Duke Telestroke Network offer regional access to care?
Through this network, Duke neurologists can see patients 24 hours a day via video monitor to provide emergent recommendations at any of eight participating North Carolina and VA hospitals. We may recommend a transfer if necessary. Our Duke Life Flight helicopters and ambulances make it possible to quickly transfer a patient to Duke for emergency eye stroke care.
What about follow-up care?
Patients receive individualized follow-up care for eye stroke. This includes diagnostic testing to better understand their condition and reduce their risk of another stroke. Patients may also be referred to our vision rehabilitation program.