Retinal Layer Reflectivity and Thickness as OCT Biomarkers for Diagnosis and Imaging-Based Stratification Relative to the 4.5-Hour Window in Acute Central Retinal Artery Occlusion - Report - MDSpire

Retinal Layer Reflectivity and Thickness as OCT Biomarkers for Diagnosis and Imaging-Based Stratification Relative to the 4.5-Hour Window in Acute Central Retinal Artery Occlusion

  • By

  • Walter, Alessandra

  • Wenzel, Daniel A.

  • Poli, Sven

  • Druchkiv, Vasyl

  • Beuse, Ansgar

  • Schultheiss, Maximilian

  • Spitzer, Martin

  • Bartz-Schmidt, Karl Ulrich

  • Grohmann, Carsten

  • April 6, 2026

  • 0 min

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Clinical Report: Assessment of Retinal Layer Reflectivity and Thickness via OCT

Overview

This study evaluates the use of optical coherence tomography (OCT) to assess retinal layer reflectivity and thickness in acute central retinal artery occlusion (CRAO) within a critical 4.5-hour reperfusion window. The findings indicate that OCT-derived metrics can effectively differentiate CRAO-affected eyes from fellow eyes and provide insights into ischemic tissue status.

Background

Acute central retinal artery occlusion (CRAO) is a neuro-ophthalmic emergency that can lead to significant visual impairment if not promptly addressed. The 4.5-hour reperfusion window is crucial for potential therapeutic interventions, emphasizing the need for rapid and accurate diagnostic tools. Optical coherence tomography (OCT) has emerged as a valuable non-invasive imaging modality that can aid in the timely diagnosis and management of CRAO.

Data Highlights

MetricAUCp-value
IRL/ORL Reflectivity Ratio0.98-0.99<0.001
Retinal Thickness (Sector-wise)0.78-0.99N/A
IRL/ORL Reflectivity Ratio (Time-to-OCT)R² 0.43-0.54N/A
RRTI Cut-off≈1.20N/A

Key Findings

  • The IRL/ORL reflectivity ratio effectively differentiates CRAO-affected eyes from fellow eyes (AUC = 0.98-0.99).
  • Retinal thickness increases in CRAO eyes across all ETDRS sectors, except the foveal center.
  • Temporal dependence is observed in both reflectivity and thickness metrics, with the IRL/ORL reflectivity ratio rising with time-to-OCT.
  • Diagnostic performance for retinal thickness varies by sector, with AUC ranging from 0.78 to 0.99.
  • RRTI increases with ischemia duration, particularly in inferior sectors.

Clinical Implications

The use of OCT-derived biomarkers can enhance the diagnostic accuracy for acute CRAO, facilitating timely intervention within the critical 4.5-hour window. These metrics may improve acute stroke triage and support telemedicine workflows, ultimately aiding in better patient outcomes.

Conclusion

Quantitative OCT biomarkers provide objective insights into ischemic tissue status in acute CRAO, underscoring their potential role in clinical practice. Further validation is needed before widespread clinical application.

Related Resources & Content

  1. American Heart Association, Professional Heart Daily, 2026 -- 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke
  2. American Academy of Ophthalmology, PubMed, 2025 -- Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern
  3. ScienceDirect, 2025 -- Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA)
  4. PMC, 2025 -- Tenecteplase in Central Retinal Artery Occlusion Study (TenCRAOS): Protocol for a randomized-controlled trial
  5. Retinal Physician, 2015 -- Appropriate Interpretation of OCT Imaging
  6. Retinal Physician, 2021 -- Retinal OCT Biomarkers for Clinicians and Clinical Researchers
  7. Ophthalmology Management — Learning to read retinal OCT
  8. Retinal Physician — Disorganization of the Retinal Inner Layers as a Prognostic Biomarker
  9. Learning to read retinal OCT
  10. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke - Professional Heart Daily | American Heart Association
  11. Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern® - PubMed
  12. Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA): a multicentre, double-dummy, patient-blinded and assessor-blinded, randomised, controlled, phase 3 trial - ScienceDirect
  13. Tenecteplase in Central Retinal Artery Occlusion Study (TenCRAOS): Protocol for a randomized-controlled trial - PMC
  14. Study Details | NCT04965038 | Early Reperfusion Therapy With Intravenous Thrombolysis for Recovery of VISION in Acute Central Retinal Artery Occlusion | ClinicalTrials.gov
  15. Optical coherence tomography findings in acute central retinal artery occlusion and their association with visual outcomes - PMC
  16. Optical Coherence Tomography Angiography (OCTA) Characteristics of Acute Retinal Arterial Occlusion: A Systematic Review - PMC

Original Source(s)

Retinal Layer Reflectivity and Thickness as OCT Biomarkers for Diagnosis and Imaging-Based Stratification Relative to the 4.5-Hour Window in Acute Central Retinal Artery Occlusion

  • by Walter, Alessandra , Wenzel, Daniel A., Poli, Sven , Druchkiv, Vasyl , Beuse, Ansgar , Schultheiss, Maximilian , Spitzer, Martin , Bartz-Schmidt, Karl Ulrich, Grohmann, Carsten

  • April 6, 2026

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