Current RMA Instruments
| Reasonable Hypothesis SOP | 50 of 2020 |
| Balance of Probabilities SOP | 51 of 2020 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Code: 362.3
- ICD-10-AM Code: H34
Brief description
This SOP covers occlusion (blockage) of either retinal arteries or retinal veins. These conditions are important causes of vision loss (both of visual acuity and visual fields) in older people.
Confirming the diagnosis
The diagnosis is made on clinical grounds. Fluorescein angiography may be needed in some cases. The diagnostic label used should specify the affected side and the type of vessel involved (artery or vein, central or branch vessel). There are some SOP factors that are specific to vein occlusion only and to artery occlusion only.
The relevant medical specialist is an ophthalmologist.
Additional diagnoses covered by SOP
- Branch retinal artery occlusion
- Branch retinal vein occlusion
- Central retinal artery occlusion
- Central retinal vein occlusion
- Hemiretinal vein occlusion
- Occlusion of a named retinal branch vessel e.g. macula branch vein/artery occlusion
- Retinal artery occlusion
- Retinal vein occlusion
Conditions that may be covered by SOP
Amaurosis fugax (temporary visual loss in one or both eyes). This is a symptom rather than a specific disease. There are multiple causes. Only unilateral temporary loss that is due to obstruction to blood flow in the retinal artery is covered by the SOP.
Conditions not covered by SOP
- Diabetic retinopathy# - propagates to diabetes mellitus SOP
- Hypertensive retinopathy# - propagates to hypertension SOP
- Ischaemic optic neuropathy
- Ophthalmic artery occlusion
- Retinal haemorrhage#
- Retinal detachment#
* Another SOP applies
# Non-SOP condition
Clinical onset
These conditions typically present in older patients (> 60 years old).
Central retinal artery occlusion presents with acute and profound loss of vision in one eye that is usually painless.
Branch retinal artery occlusion typically presents with acute painless visual loss in one eye, which may be restricted to just part of the visual field. Visual acuity loss occurs in less than half of cases.
Central retinal vein occlusion usually presents with the acute onset of painless blurred vision in one eye.
Subjects with branch retinal vein occlusion tend to be asymptomatic, with diagnosis made on routine ophthalmologic examination.
Clinical worsening
Worsening would most likely be evidenced by a further deterioration in vision, due to new, additional occlusion of a retinal artery or vein. With the exception of steroids for central retinal artery occlusion in patients with giant cell arteritis, there are no treatments that are known to influence the acute course of the condition. Management is directed at secondary complications and at trying to prevent recurrences, by treating underlying conditions.