{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:33:17Z","timestamp":1789702397074,"version":"4.0.1"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,7]]},"abstract":"\n Background<\/jats:title>\n Prompt diagnosis of acute central retinal artery occlusion (CRAO) is crucial for therapeutic management and stroke prevention. However, most stroke centers lack onsite ophthalmic expertise before considering fibrinolytic treatment. This study aimed to develop, train, and test a deep learning system to detect hyperacute CRAO on retinal fundus photographs within the critical 4.5\u2010hour treatment window and up to 24\u2009hours after visual loss to aid in secondary stroke prevention.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Our retrospective, cross\u2010sectional study included 1322 color fundus photographs from 771 patients with acute visual loss due to CRAO, central retinal vein occlusion, nonarteritic anterior ischemic optic neuropathy, and healthy controls. Photographs were collected from 9 expert neuro\u2010ophthalmology centers in 6 countries, including 3 randomized clinical trials. Training included 1039 photographs (517 patients), followed by testing on 2 data sets: (1) hyperacute CRAO (54 photographs, 54 patients) and (2) CRAO within 24\u2009hours after visual loss (110 photographs, 109 patients).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The deep learning system achieved an area under the receiver operating characteristic curve of 0.96 (95% confidence interval (CI), 0.95\u20130.98), a sensitivity of 92.6% (95% CI, 87.0\u201398.0), and a specificity of 85.0% (95% CI, 81.8\u201392.8) for detecting CRAO at hyperacute stage, with similar results within 24\u2009hours. The deep learning system outperformed stroke neurologists on a subset of hyperacute testing data set (120 photographs, 120 patients).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A deep learning system can accurately detect hyperacute CRAO on retinal photographs within a time window compatible with urgent fibrinolysis. If further validated, such systems could improve patient selection for fibrinolytic trials and optimize secondary stroke prevention.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n \n URL:\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n ; Unique identifier: NCT06390579.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.124.041441","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:58:17Z","timestamp":1751003897000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Artificial Intelligence\u2010Based Detection of Central Retinal Artery Occlusion Within 4.5\u2009Hours on Standard Fundus Photographs"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9370-8877","authenticated-orcid":false,"given":"Ayse","family":"Gungor","sequence":"first","affiliation":[{"name":"Rothschild Foundation Hospital","place":["Paris, France"]},{"name":"Rothschild Foundation Hospital","place":["Paris, France"]},{"name":"Sorbonne Universit\u00e9, Institut du Cerveau\u2014Paris Brain Institute\u2014ICM, Inria, Inserm, CNRS, APHP, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4437-7897","authenticated-orcid":false,"given":"Ilias","family":"Sarbout","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital","place":["Paris, France"]},{"name":"Rothschild Foundation Hospital","place":["Paris, France"]},{"name":"Sorbonne Universit\u00e9, Institut du Cerveau\u2014Paris Brain Institute\u2014ICM, Inria, Inserm, CNRS, APHP, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6920-8155","authenticated-orcid":false,"given":"Aubrey L.","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California","place":["Vallejo, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Hamann","sequence":"additional","affiliation":[{"name":"Copenhagen University Hospital\u2014Rigshospitalet","place":["Glostrup, Denmark"]},{"name":"University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3355-7715","authenticated-orcid":false,"given":"Pierre","family":"Lebranchu","sequence":"additional","affiliation":[{"name":"Nantes Universit\u00e9, Service d\u2019Ophtalmologie CHU Nantes, \u00c9cole Centrale Nantes, LS2N, UMR6004","place":["Nantes, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Hobeanu","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0477-3046","authenticated-orcid":false,"given":"Philippe","family":"Gohier","sequence":"additional","affiliation":[{"name":"University Hospital","place":["Angers, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Vignal\u2010Clermont","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2033-449X","authenticated-orcid":false,"given":"Oana M.","family":"Dumitrascu","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Scottsdale, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1181-4379","authenticated-orcid":false,"given":"Salomon\u2010Yves","family":"Cohen","sequence":"additional","affiliation":[{"name":"Ophthalmic Imaging and Laser Center (CIL)","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-5905","authenticated-orcid":false,"given":"Wolf A.","family":"Lagr\u00e8ze","sequence":"additional","affiliation":[{"name":"University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6857-3003","authenticated-orcid":false,"given":"Nicolas","family":"Feltgen","sequence":"additional","affiliation":[{"name":"Medical Center, University of Gottingen","place":["Gottingen, Germany"]},{"name":"Basel University Hospital","place":["Basel, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"van der Heide","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital","place":["Paris, France"]},{"name":"Rothschild Foundation Hospital","place":["Paris, France"]},{"name":"Universit\u00e9 Paris Cit\u00e9, Inserm U1153","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6951-8487","authenticated-orcid":false,"given":"C\u00e9dric","family":"Lamirel","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2972-5227","authenticated-orcid":false,"given":"Jost B.","family":"Jonas","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital","place":["Paris, France"]},{"name":"Singapore Eye Research Institute, Singapore National Eye Center","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6777-6311","authenticated-orcid":false,"given":"Michael","family":"Obadia","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9416-1803","authenticated-orcid":false,"given":"Daniel","family":"Racoceanu","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, Institut du Cerveau\u2014Paris Brain Institute\u2014ICM, Inria, Inserm, CNRS, APHP, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6388-8639","authenticated-orcid":false,"given":"Dan","family":"Milea","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital","place":["Paris, France"]},{"name":"Rothschild Foundation Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000366"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-019-0576-y"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2019.01.021"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2015.07.018"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2015.1578"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2005.03.038"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0014-4835(03)00214-8"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930231189352"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.028743"},{"key":"e_1_3_2_11_2","unstructured":"Guillon B Preterre C Obadia M Mourand I Gaudron M Sablot D Godeneche G Marc G Rodier G Urbanczyk C et\u00a0al. Oral communication at the 16th World Stroke Congress. A randomized controlled trial of alteplase initiated within 4.5 hours of central retinal artery occlusion. THEIA Study. 2024."},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-017-8702-x"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/WNO.0000000000001409"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2023.01.005"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/WNO.0000000000001214"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14735"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105531"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.121.10.1377"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.03.061"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105988"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-020-0889-x"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12886-023-03176-w"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.iae.0000238095.97104.9b"},{"key":"e_1_3_2_24_2","first-page":"283","article-title":"Multimodal imaging of acute central retinal artery occlusion","volume":"8","author":"Abdellah MM","year":"2019","unstructured":"Abdellah MM. Multimodal imaging of acute central retinal artery occlusion. Med Hypothesis Discov Innov Ophthalmol. 2019;8:283\u2013290.","journal-title":"Med Hypothesis Discov Innov Ophthalmol"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00980-y"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1056\/AIoa2400190"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1917130"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/WNO.0000000000001800"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(22)00169-8"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-1037-7"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-1034-x"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_3_2_33_2","unstructured":"A Phase III Randomized Blind Double Dummy Multicenter Study Assessing the Efficacy and Safety of IV THrombolysis (Alteplase) in Patients With acutE Central retInal Artery Occlusion (THEIA) \u2010 ClinicalTrials.gov Identifier: NCT03197194."},{"key":"e_1_3_2_34_2","unstructured":"TENecteplase in Central Retinal Artery Occlusion Stuy (TenCRAOS) \u2010 ClinicalTrials.gov Identifier: NCT04526951."},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2023.3313786"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-021-25138-w"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.29207\/resti.v8i1.5367"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpls.2022.820146"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","unstructured":"Selvaraju RR Cogswell M Das A Vedantam R Parikh D Batra D. Grad\u2010CAM: Visual Explanations from Deep Networks via Gradient\u2010Based Localization. 2017 IEEE International Conference on Computer Vision (ICCV). 2017:618\u2013626. doi: 10.1109\/ICCV.2017.74","DOI":"10.1109\/ICCV.2017.74"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.procs.2022.12.111"},{"key":"e_1_3_2_41_2","unstructured":"Hemelings R Wong DWK Eijgen JV Chua J Breda JB Stalmans I Schmetterer L. Predicting glaucomatous visual field progression from baseline fundus photos using deep learning. ARVO Annual Meeting Abstract June 2023. Investigative Ophthalmology & Visual Science. 2023 380. https:\/\/iovs.arvojournals.org\/article.aspx?articleid=2790046."},{"key":"e_1_3_2_42_2","unstructured":"Milea L Najjar RP. Classif\u2010Eye. GitHub. 2020 https:\/\/github.com\/milealeonard\/Classif\u2010Eye."},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1177\/0962280218794733"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2012.03.005"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2024.4269"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.124.041441","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:57:09Z","timestamp":1753876629000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.124.041441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":44,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1161\/JAHA.124.041441"],"URL":"https:\/\/doi.org\/10.1161\/jaha.124.041441","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"2025-02-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e041441"}}