Ocular findings as predictors of carotid artery occlusive disease: is carotid imaging justified?
OBJECTIVE
Hemispheric neurologic symptoms, amaurosis fugax, and Hollenhorst plaques at eye examination are standard indications for carotid imaging to identify carotid artery occlusive disease (CAOD). Previous reports have suggested that other ocular findings, such as retinal artery occlusion and anterior ischemic optic neuropathy, are associated with CAOD. However, the predictive value of ocular findings for the presence of CAOD is controversial. The purpose of this study was to define the predictive value of ocular symptoms and ophthalmologic examination in identifying significant CAOD.


METHODS
Over 3 years 145 patients were referred for carotid imaging on the basis of ocular indications in 160 eyes. Forty patients were excluded because of concurrent non-ocular indications for carotid imaging, leaving 105 patients referred exclusively for ocular indications to evaluate. Ophthalmologic history and eye examination were correlated with carotid duplex ultrasound findings.


RESULTS
Amaurosis fugax was associated with a positive scan in 20.0% of carotid arteries (P =.022). Hollenhorst plaques at fundoscopic examination were associated with a positive scan in 18.2% of carotid arteries (P =.02). Ocular findings exclusive of Hollenhorst plaques were particularly poor predictors of CAOD, inasmuch as only 1 of 64 arteries (1.6%) had significant ipsilateral internal carotid artery stenosis (P =.022). Venous stasis retinopathy was the only ocular finding other than Hollenhorst plaques with any predictive value (1 of 5 scans positive; positive predictive value, 20.0%).


CONCLUSIONS
Ocular symptoms and findings are poor predictors of CAOD. Amaurosis fugax, Hollenhorst plaques, and venous stasis retinopathy demonstrated moderate predictive value, whereas all other ocular findings demonstrated no predictive value in identifying CAOD.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, 75390, USA.
Heath K
HK
McCullough
Carol G
CG
Reinert
Linda S
LS
Hynan
Christy L
CL
Albiston
Mary H
MH
Inman
Patty I
PI
Boyd
M Burress
MB
Welborn
G Patrick
GP
Clagett
J Gregory
JG
Modrall
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020757:Amaurosis Fugax / Q000150:complications / Q000175:diagnosis; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging*; D005128:Eye Diseases / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D011237:Predictive Value of Tests; D012164:Retinal Diseases / Q000150:complications / Q000175:diagnosis; D018616:Ultrasonography, Doppler, Duplex