Structural and Functional Imaging of the Retina in Central Retinal Artery Occlusion – Current Approaches and Future Directions

Brian Mac Grory, Matthew Schrag, Sven Poli, Chantal J. Boisvert, Martin S. Spitzer, Maximillian Schultheiss, Max Nedelmann, Shadi Yaghi, Mary Guhwe, Elizabeth E. Moore, Hunter R. Hewitt, Kelsey M. Barter, Taewon Kim, Maomao Chen, Lucas Humayun, Chang Peng, Pratik Y. Chhatbar, Patrick Lavin, Xuxiang Zhang, Xiaoning JiangEytan Raz, Shiv Saidha, Junjie Yao, Valérie Biousse, Wuwei Feng

Research output: Contribution to journalReview articlepeer-review


Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke which affects the retina. Intravenous thrombolysis is emerging as a compelling therapeutic approach. However, it is not known which patients may benefit from this therapy because there are no imaging modalities that adequately distinguish viable retina from irreversibly infarcted retina. The inner retina receives arterial supply from the central retinal artery and there is robust collateralization between this circulation and the outer retinal circulation, provided by the posterior ciliary circulation. Fundus photography can show canonical changes associated with CRAO including a cherry-red spot, arteriolar boxcarring and retinal pallor. Fluorescein angiography provides 2-dimensional imaging of the retinal circulation and can distinguish a complete from a partial CRAO as well as central versus peripheral retinal non-perfusion. Transorbital ultrasonography may assay flow through the central retinal artery and is useful in the exclusion of other orbital pathology that can mimic CRAO. Optical coherence tomography provides structural information on the different layers of the retina and exploratory work has described its utility in determining the time since onset of ischemia. Two experimental techniques are discussed. 1) Retinal functional imaging permits generation of capillary perfusion maps and can assay retinal oxygenation and blood flow velocity. 2) Photoacoustic imaging combines the principles of optical excitation and ultrasonic detection and - in animal studies - has been used to determine the retinal oxygen metabolic rate. Future techniques to determine retinal viability in clinical practice will require rapid, easily used, and reproducible methods that can be deployed in the emergency setting.

Original languageEnglish (US)
Article number105828
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number7
StatePublished - Jul 2021


  • Central Retinal Artery Occlusion
  • Fluorescein Angiography
  • Intravenous Thrombolysis
  • Ischemic Penumbra
  • Ischemic Stroke
  • Optical Coherence Tomography
  • Photoacoustic Imaging
  • Ultrasound

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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