title: Does a visible retinal embolus increase the likelihood of hemodynamically significant carotid artery stenosis in patients with acute retinal arterial occlusion?
abstract: 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 > or = 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.
authors.affiliation: Department of Ophthalmology, Queen's University, Kingston, Ontario.
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: G C
authors.initials: GC
authors.lastname: Brown
authors.forename: J L
authors.initials: JL
authors.lastname: Pater
authors.forename: A F
authors.initials: AF
authors.lastname: Cruess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011336:Probability; D015203:Reproducibility of Results; D015356:Retinal Artery Occlusion / Q000175:diagnosis*; D012171:Retinal Vessels / Q000473:pathology*; D012680:Sensitivity and Specificity; D013923:Thromboembolism / Q000175:diagnosis*