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 * Note: Please use your sandbox to submit assignment # 3 by pasting it below. When uploading your improvements to the article talk page please share your exact proposed edit (not the full assignment 3).


 * Talk Page Template: CARL Medical Editing Initiative/Fall 2019/Talk Page Template

Central Retinal Artery Occlusion.

Change 1:
Add: CRAO can be classified based on it pathogenesis, as arteritic versus non-arteritic.  

Change 2:
"The most common cause for CRAO is carotid artery atherosclerosis." --> change to --> "Non-arteritic CRAO is most commonly caused by an embolus and occlusion at the narrowest part of the carotid retinal artery due to plaques in the carotid artery resulting in carotid retinal artery atherosclerosis. 

Change 3:
Add: '''Further causes of non-arteritic CRAO may include vasculitis and chronic systemic autoimmune diseases. '''"

Change 4:
"In patients of 70 years of age and older, giant cell arteritis is more likely to be the cause than in younger patients." --> change to --> "Arteritic CRAO is most commonly caused by giant cell arteritis.  "

Overall changes:
"Causes of CRAO may be examined based on its various classifications, including non-arteritic and arteritic CRAO.  Non-arteritic CRAO is most commonly caused by an embolus and occlusion at the narrowest part of the carotid retinal artery due to plaques in the carotid artery resulting in carotid retinal artery atherosclerosis.   Further causes of non-arteritic CRAO may include vasculitis and chronic systemic autoimmune diseases. Arteritic CRAO is most commonly caused by giant cell arteritis.   "

Change 1:
The aim of this sentence was to introduce readers to the existence of and distinction between various subclassifications of CRAO, and how different classifications have different causes. The previous version of the article did not introduce such classifications, and was not specific as to which type of CRAO can be attributable to which cause. The organization of CRAO into subclassifications was consistent across all three cited sources, therefore I believe its inclusion is justified.

Controversy: There may be some controversy with the proposed change, as the addition of subclassifications of CRAO will lead to a restructuring of the "Causes" section of the Wikipedia article. However, I believe this restructuring is necessary, as discussing causes of generalized CRAO is not specific enough in my opinion. I believe more detailed and pointed information about causes of specific subtypes of CRAO will prove useful for readers.

Change 2:
While the aim of the original sentence of how carotid artery atherosclerosis is a common cause of CRAO was maintained, this sentence was expanded on to explain how atherosclerosis can lead to the formation of an embolus in non-arteritic CRAO specifically, which was brought up by all three cited authors.

No controversy with this change has been identified.

Change 3:
This sentence was added to include additional causes of non-arteritic CRAO other than embolus. These additional causes are supported by both Dr. Sanjay Sharma and Dr. Sohan Hayreh, a leading expert in this field.

No controversy with this change has been identified.

Change 4:
This sentence was modified to remove the age of 70 years old as a risk factor for giant cell arteritis, as information regarding which age group this complication was most prevalent in varied in the literature, and no one age was found to be definite. The sentence was restructured to emphasize the main point of giant cell arteritis being the main cause of arteritic CRAO, as evidenced by consistent information across all three sources.

There is the potential for controversy surrounding the removal of the age of 70 years old as a risk factor for giant cell arteritis, however this fact was not cited in the original Wikipedia article, and the literature cites a wide variety of ages, such as 70-80 years old (Laldinpuii, 2008), and over 60 years old (Chacko, 2015). Therefore, I do not believe 70 years old is a definitive age for being a risk factor for giant cell arteritis, and I believe this justifies removal of this from the article.

References:

Chacko, J. G., Chacko J. A., Salter, M. W. (2015). Review of Giant cell arteritis. Saudi Journal of Ophthalmology, 29(2), 48-52. Retrieved from: https://www.sciencedirect.com/science/article/pii/S1319453414001167

Laldinpuii, J., Sanchetee, P., Borah, A. L., Ghose, M., & Borah, N. C. (2008). Giant cell arteritis (temporal arteritis): A report of four cases from north east India. Annals of Indian Academy of Neurology, 11(3), 185-189. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771971/

Source 1:
The first source is a recent (2018) review article by Dr. Sohan Hayreh, an Ophthalmologist at the University of Iowa and leading expert in the field of Ophthalmology. The article was published in the Indian Journal of Ophthalmology, and one critique is that the journal is relatively low impact, with an impact score of 0.977. Furthermore, many of the studies and references cited by the author are other published works also by the author, which may represent a form of selection bias. However, the information presented by the author appeared consistent across all reviewed articles and did not appear biased. Finally, some of the references cited were over seven years old, which may lead to potentially outdated information. The author declared no conflicts of interest.

Source 2:
The second source is a systematic review article from 2013 by D D Varma et al. The article was published in Eye, the official journal of the Royal College of Ophthalmologists, and has an impact score of 2.366. The author declared no conflicts of interest. The author employed a search strategy using PubMed, The Cochrane Database, and The ACP Journal Club from 1990 to 2012. A variety of search terms and tools were used to help build the search. Two independent authors reviewed each article separately. The use of both PubMed and the Cochrane Database represents a wide variety of literature, and the search strategy employed seems thorough and unbiased. Furthermore, articles in both English and non-English languages were cited, which eliminated potential language bias.

Source 3:
The third source is a recent (2017) review article by Dr. Michael Dattilo, an Ophthalmologist at Department of Ophthalmology, Emory University School of Medicine. The article was published in Neurologic Clinics, with an impact factor of 2.802. Some of the references cited were over seven years old, which may lead to potentially outdated information. While the first author declared no conflicts of interest, supporting authors declared themselves to be consultants for biologics and pharmaceutical companies, which may lead to bias.

Assignment 2
Citation:

Hayreh, S. S. (2018, December). Central retinal artery occlusion. Indian Journal of Ophthalmology, 66(12), 1684-1694. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256872/

Answers to questions:

1. How you searched for a source (search strategy – where you went to find it).

Pubmed advanced search was used to find articles detailing the causes of central retinal artery occlusion, by searching for the keywords “cause” or “etiology” and “CRAO” or “central retinal artery occlusion.” Next, articles were filtered based on the criteria of being a review article, written in the last 7 years, and written in English.

2. What potential sources were identified and considered (give examples of 1 or 2).

Other citations considered:

Varma, D. D., Cugati, S., Lee, A. W., & Chen, C. S. (2013, June). A review of central retinal artery occlusion: clinical presentation and management. Eye, 27(6), 688-697. Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682348/

Dattilo, M., Biousse, V., & Newman, N. J. (2017, February). Update on the management of central retinal artery occlusion. Neurologic Clinics, 35(1), 83-100. Retrieved from:

https://www.sciencedirect.com/science/article/pii/S073386191630072X?via%3Dihub

The above citations were considered due to their relevance towards the topic and meeting the predetermined search criteria. However, the article by Varma et al was not chosen due to a greater focus on risk factors rather than etiology of the disease, and the article by Dattilo et al was not chosen as the causes were not explored to as in-depth of a degree as the chosen article by Hayreh.

3. Why the source was chosen (what made it better than other choices).

The article by Hayreh was chosen for several reasons. Firstly, the article was the most recent out of the articles considered, with the publication date being December 2018. The article also appeared to be a high-quality source of evidence, as it came from a peer-reviewed journal, had no conflicts of interest as stated by the author, and the author had published other work in several other peer-reviewed Ophthalmology-oriented journals. Another reason this article was selected was due to the clear and organized layout of the various causes of CRAO. Many of these causes were also referenced in other review articles, however they were explained in more depth here. As the current version of the Wikipedia article does not highlight some of these causes, I felt it was important to select an article that would fill these gaps in knowledge.

4. List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria.

Three reasons why this meets the criteria set by Wikipedia (MEDRS):


 * 1) Having been published in 2018, the article is very recent and meets the Wikipedia criteria for being published in the last 5 years.
 * 2) The article comes from an open access, peer-reviewed journal.
 * 3) The article is an unbiased secondary source, and used a variety of high-quality sources (Ophthalmology, British Journal of Ophthalmology, American Journal of Ophthalmology) to provide information.

5. How do you plan to use the source for improving the article?

I plan to use this source to help provide clear information pertaining to the various causes of CRAO. In particular, I hope to clarify the different causes/etiologies for the different subtypes of CRAO. I plan to specify how non-arteritic CRAO is mostly caused by traveling emboli originating from plaques in the carotid artery or heart, and how it may also be caused by vasculitis, chronic systemic autoimmune diseases, or thrombophilia to a lesser degree. I plan to distinguish how arteritic CRAO is caused by giant cell arteritis. Identifying and explaining how giant cell arteritis is a cause of arteritic CRAO is a priority for myself and my group, as advised by our tutor Dr. Sharma.