Abstract Body:
Introduction
The 2021 AHA/ASA Scientific Statement on Retinal Artery Occlusion (RAO) indicated treatment with thrombolytics may be effective and systems should prioritize its early recognition. We describe the phased deployment of fundus cameras across 10 Emergency Departments (EDs) in a southern California health system for emergent visualization and diagnosis of monocular vision loss.

Methods
Program Development: In 2022, Vascular Neurology, ED and Ophthalmology initiated discussions to deploy fundus cameras to support emergent diagnosis of monocular vision loss. The fundus camera image ordering was integrated with the electronic medical record (EMR). Department leaders socialized the program with training sessions and job aids.
Operational Scope: Any medical professional working in the ED was permitted to operate the device. A small group of “superusers” were identified at each medical center to obtain competency in camera operation. In-person training sessions for ED physicians/staff covered order placement, image capture and transmission, troubleshooting and device maintenance.
Acute Vision Loss Workflow: Patients presenting with monocular vision loss within 4.5 hours of last known well time follow the code stroke algorithm predicated on BEFAST symptoms. A stat CTH is obtained, followed by a teleneurologist examination. If patient presents with only monocular vision loss, a fundus photo is captured and remotely emergently interpreted by an ophthalmologist. If photo is consistent with an RAO, thrombolysis is offered.

Results
From July 2022 to June 2024, 1079 fundus photos were obtained across 10 stroke centers. The mean age (SD) was 55.9yrs (17.6). The percent female was 55%. The racial/ethnic breakdown of individuals who had a fundus photo was 32.4% White, 14.5% Black, 12.1% Asian, 7.9% Other and 33% Hispanic. 27 (2.5%) of patients were diagnosed with RAO, out of which 4 patients received thrombolytics. Non-thrombolytic patients were given antiplatelets and admitted for further assessment of RAO etiology. Those who did not receive thrombolytics were all outside of the 4.5-hour time to treat. 26 (2.5%) had a final diagnosis of a cerebral ischemic stroke.

Conclusion
Fundus camera deployment for the assessment of acute monocular vision loss improves management of RAO patients with thrombolytics and/or allows further assessment of the etiology in a more urgent manner.