‘Time Is Vision’ in Eye Stroke Treatment

Quick action by Moran’s ophthalmic hospitalist helps prevent blindness in eye stroke patient.

On a summer afternoon in 2023, as Frody Volgger neared the end of a motorcycle ride on Utah’s scenic Monte Cristo Loop, he suddenly lost vision in his right eye. He gestured to his riding partner and pulled to the side of the road.

“I thought I had something in my eye,” Volgger, 72, says. “I took my glasses and helmet off, closed my good eye, and saw only darkness and a few stars. There was no warning, no pain. I just couldn’t see a thing.”

He considered going home to change clothes and get his car before heading to the emergency room at University of Utah Hospital, but instead, he rode straight there. That decision made a world of difference.

Based on Volgger’s complaint of sudden vision loss in one eye, the emergency department (ED) triage nurse and neurology team called a possible “brain attack,” which alerted the hospital’s stroke team as well as John A. Moran Eye Center ophthalmic hospitalist, Theresa Long, MD, and her consulting resident that day, Ayesha Patil, MD.

“We were nearby and able to drop everything and head right to the ED,” says Long. “Neurologists say ‘time is brain’ regarding stroke and the promptness needed to respond. We say ‘time is vision’ when it comes to sudden vision loss and the need to respond.”

Long and Patil met Volgger—motorcycle gear and all—as he received a CT scan. They walked him back to the ED, dilated his eyes, quickly performed a range of tests, and evaluated radiographic images that indicated Volgger had experienced a retinal artery occlusion (RAO), also known as an eye stroke.

Once Long diagnosed RAO, the team promptly followed the protocol to prepare and inject Volgger with a “clot-busting” medication.

“The arteries that lead to the brain are like an interstate highway,” says Long. “Fortunately for Frody, the blockage in his artery took the first exit ‘off the interstate’ and headed to his eye rather than further up to his brain. The sudden vision loss was a warning sign, a possible precursor to a stroke. Because everyone acted so quickly and administered appropriate medicine within an hour of arrival, we saved about 30% of normal vision in that eye. This is a big deal—these patients are usually permanently blind in the affected eye. We also admitted him to the hospital for monitoring and treatment to prevent another stroke.”

Frody Volgger, left, talks with the ophthalmologists who treated his eye stroke, Theresa Long, MD, center, and Ayesha Patil, MD, during a follow-up visit at Moran.

Volgger says he’s “incredibly grateful and amazed” at how everybody responded. “I’m back on my motorcycle—feeling good and very lucky.”

Frody Volgger is back to riding his motorcycle after requiring emergency medical treatment for an eye stroke.

What You Need to Know About Retinal Artery Occlusion

Retinal artery occlusion (RAO) is a type of stroke marked by a loss of blood supply in the retina, the light-sensitive layers of nerve tissue at the back of the eye. Since the eye is an extension of the brain, loss of blood supply and oxygen for a short period leads to severe and irreversible complications and permanent vision loss.

Doctors consider RAO a medical emergency and a possible warning sign for an impending brain stroke.

Symptoms

Sudden onset of painless, dramatic vision loss and loss of side vision in one eye could indicate RAO.

Take Action

Anyone who experiences sudden vision loss should call 911 and get to an emergency room as soon as possible.

Risk Factors

RAO risk factors include obesity, high blood pressure, smoking, high cholesterol, diabetes, and atrial fibrillation.

Treatment

A “clot-busting” treatment is most effective when given within 3 hours, but no longer than 4 1/2 hours after the onset of symptoms.