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Article | AAO 2026

When Retinal Findings Point to a Vascular Emergency

How to respond to high blood pressure, Hollenhorst plaques, and other vascular findings.

By: Sarah Fackler, managing editor, Optometric Management and Eyecare Business
Optometric Management October 2, 2026
5 Key Takeaways

  • 1

    High blood pressure, sudden vision loss, and Hollenhorst plaques indicate vascular disease but require different responses from optometrists.

  • 2

    Severe asymptomatic hypertension differs from a hypertensive emergency, which involves blood pressure above 180/120 mmHg with target-organ damage.

  • 3

    Retinal artery occlusion (RAO) is classified as a stroke, with central retinal artery occlusion (CRAO) occurring at an estimated rate of 2 cases per 100,000 person-years.

  • 4

    Hollenhorst plaques are cholesterol emboli that require cardiovascular evaluation, with 75% being asymptomatic but still necessitating follow-up.

  • 5

    Transient ischemic attack (TIA) has a 10% stroke risk within 90 days, warranting immediate referral to the emergency department for symptoms within 48 hours.