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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).


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Wikipedia Assignment Part 2: Literature Search SGL Group #7 November 6th, 2019 Topic: Central retinal artery occlusion
Signs and symptoms - Morgan Citation Varma, D., Cugati, S., Lee, A. et al. A review of central retinal artery occlusion: clinical presentation and management. Eye 27, 688–697 (2013) doi:10.1038/eye.2013.25

Answers to questions: 1. How you searched for a source (search strategy – where you went to find it). To search for the above citation, PubMed was used. Advanced search was used specifically to find review articles describing signs and symptoms of central retinal artery occlusion (CRAO) within the past 5-7 years. 48 items were found.

2. What potential sources were identified and considered (give examples of 1 or 2). Besides the article ultimately chosen (Varma et al. (2013)) another article that was given consideration was Hayreh (2018). While being a more recent article, some issues that I had with this review included: being published in a lesser-known journal, having a sole author, and, relatedly, having clear opinions within the text that do not seem to be entirely substantiated by the literature. Examples of this include how Hayreh SS approaches patients that arrive with suspected CRAO. This may be indicative of a bias, and thus may not be appropriate for consultation when looking for signs and symptoms.

3. Why the source was chosen (what made it better than other choices). Varma et al. (2013) was identified as the best possible source using my search strategy because it is a relatively recent article published in a reputable journal (Nature Eye) and was centred around the presentation and management of CRAO. Thus, this article would describe the relevant signs and symptoms and could be useful for extracting information from. The reputability of the journal is what solidified my decision for using this article -- I could trust that the information was peer-reviewed and accurate.

4) List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria. Three reasons that this article meets the MEDRS criteria set by Wikipedia are: It is an unbiased secondary source (a review). It is accessible to everyone who wishes to view it (no paywall). It was published within the last 7 years, which makes it a relatively recent, up-to-date article.

5) How do you plan to use the source for improving the article? I plan on using this source to supplement the signs and symptoms portion of the Central Retinal Artery Occlusion Wikipedia page. Due to this being a review article, I believe there should be ample information to accurately and concisely update this section.

Causes - Alanna 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): Having been published in 2018, the article is very recent and meets the Wikipedia criteria for being published in the last 5 years. The article comes from an open access, peer-reviewed journal. 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.

Mechanism/Pathophysiology - Olivia Citation: Michalinos, A., Zogana, S., Kotsiomitis, E., Mazarakis, A., & Troupis, T. (2015). Anatomy of the Ophthalmic Artery: A Review concerning Its Modern Surgical and Clinical Applications. Anatomy Research International, 2015, 1–8. 10.1155/2015/591961

Answers to questions: 1) How you searched for a source (search strategy – where you went to find it). To research this subsection of central retinal artery occlusion, Pubmed advanced search was employed filtering for only review articles within the past 5 years. This was further refined by focusing on those centered on the anatomy.

2) What potential sources were identified and considered (give examples of 1 or 2). I considered numerous articles I found through my pubmed search to contribute to the improvement of the wikipedia article such as these: Estrada, R., Allingham, M. J., Mettu, P. S., Cousins, S. W., Tomasi, C., & Farsiu, S. (2015). Retinal Artery-Vein Classification via Topology Estimation. IEEE Transactions on Medical Imaging, 34(12), 2518–2534. 10.1109/TMI.2015.2443117 Newman, A., Andrew, N., & Casson, R. (2018). Review of the association between retinal microvascular characteristics and eye disease. Clinical & Experimental Ophthalmology, 46(5), 531–552. 10.1111/ceo.13119 Although the first article (Estrada et al. 2015) was from an excellent reliable journal I was familiar with, it was too focused on the modeling of the artery rather than its clinically understood anatomy. Additionally, I found that the second article (Newman et al. 2018), was promising in terms of the journal relevance, the article title and comprehensive list of references for the review. However, it lacked a focus on the mechanism of the occlusion that addressed our gap in information.

The citation listed above my answer to question 1, is a review article I found that addressed some gaps in knowledge I was aiming to complete.

Findings of article: A review of the ophthalmic artery and its branches, including the retinal arteries Sample sentences of information gathered: Central retinal artery occlusion is most often due to emboli blocking the artery and resultantly preventing nutrients from reaching large portions of the retina. These emboli originate from the carotid arteries most of the time but in 25% of cases this is due to plaque build up in the ophthalmic artery. The most frequent site of blockage is at the most narrow part of the artery which is where the artery pierces the dura covering the optic nerve.

3) Why the source was chosen (what made it better than other choices). Although this article refers to the ophthalmic artery in its title, the central retinal artery is a branch off of the ophthalmic artery. Therefore it is an article enlightening for this topic of study as it details all of the ophthalmic artery branches including the central retinal artery’s course and pathologies. This included more anatomy specific detail compared to other central retinal artery focused articles that emphasized treatment.

4) List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria. - This article was published within the last 5 years and is therefore recent and relevant - It comes from a reliable anatomy journal (Anatomy Research International) - It is a review article in nature that seems to use a variety of reliable sources to summarize the information on this topic

5) How do you plan to use the source for improving the article? This article and the findings from it will be used to expand the mechanism subsection of the article connecting the anatomy with the causes of the disease their resulting consequences, creating a more complete explanation.

Treatment - Joanie Citation: Chronopoulos, A., & Schuzt, J. (2019, Jul). Central retinal artery occlusion - A new, provisional treatment approach. Survey of Ophthalmology, 64(4), 443-451.

Answers to questions: 1) How you searched for a source (search strategy – where you went to find it). I used PubMed to search for a reference using the filter “review” and “published in the last 5 years”. My search provided me with 96 articles.

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

Singh Hayreh, S. (2018, 12). Central retinal artery occlusion. Indian Journal of Ophthalmology, 66(12), 1684-1694. 3) Why the source was chosen (what made it better than other choices). I chose the first article because it is a good review of all the different treatments for CRAO and it presents previous methods and new methods that could lead to change. Also, this article is from a reputable ophthalmology journal.

4) List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria. The article chosen meets multiple MEDRS criteria, including the following: review article published in a reputable journal, is a primary source and reflect current medical knowledge.

5) How do you plan to use the source for improving the article? This review article will be used to update the information on the current wikipedia page with the most relevant and current medical treatment for CROA. Prognosis/Epidemiology - Hannah Citation: Tobalem S, Schutz JS, Chronopoulos A. Central retinal artery occlusion – rethinking retinal survival time. BMC Ophthalmol. 2018;18(1):101. doi:10.1186/s12886-018-0768-4

Answers to questions: 1. How you searched for a source (search strategy – where you went to find it). I searched for this source by searching “Central retinal artery occlusion” with “epidemiology” or “risk factors” on PubMed and selecting “published the last five years” and “review articles”. Please find my search strategy below.

2. What potential sources were identified and considered (give examples of 1 or 2). Other citations considered: Limaye K, Wall M, Uwaydat S, et al. Is Management of Central Retinal Artery Occlusion the Next Frontier in Cerebrovascular Diseases? J Stroke Cerebrovasc Dis. 2018;27(10):2781-2791. doi:10.1016/j.jstrokecerebrovasdis.2018.06.006

Woo, S. C., Lip, G. Y., & Lip, P. L. (2016). Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review. Eye (London, England), 30(8), 1031–1038. doi:10.1038/eye.2016.111

The above citations were also considered, due to the first article’s recency and the second article’s recent publication date and connection to CRAO as a risk factor for strokes and other diseases informing a patient’s prognosis. However, the first article was not used because of its focus on management of CRAO in treating CVD and the second article was not used because it did not expand upon risk factors for developing CRAO.

3. Why the source was chosen (what made it better than other choices). The article chosen was the best choice because it is recent (published in 2018), from a peer-reviewed journal, it is a secondary source (systematic review), and it is relevant to the prognosis of retinal artery occlusion. Specifically, it provides an updated prognosis of retinal infarction following CRAO from 90 minutes, which is currently cited on the Wikipedia page, to 12-15 minutes (Tobalem et al. 2018).

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. This article is a secondary source. Systematic reviews/meta-analyses are found at the top of the hierarchy of critically appraised evidence, as indicated on the MEDRS criteria page. 2. This article is in an open-access, peer reviewed journal. 3. The information in this article is up-to-date, given its recent publication in 2018.

5. How do you plan to use the source for improving the article? I plan to use this source to contribute to and improve the “Prognosis” section of the Wikipedia page on central retinal artery occlusion. I will first critically appraise the article, ensuring the studies included in the review do not contribute to any heterogeneity in findings. Next, I will extract the relevant information and add it to the sections of the Wikipedia page in a digestible manner, using non-scientific terminology where appropriate. Using the information in this article, I plan to correct the current prognosis included on the Wikipedia page to the updated values presented in this systematic review.

Diagnosis (Fundoscopy/Angiography)- Taylor Citations: Hayreh S. S. (2018). Central retinal artery occlusion. Indian journal of ophthalmology, 66(12), 1684–1694. doi:10.4103/ijo.IJO_1446_18

https://emedicine.medscape.com/article/1223625-workup#c5

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

Search strategy for resource 1 When using PubMed as a method of finding a resource my search strategy generated 11 results, unfortunately within these 11 articles only a fraction contained information on the diagnosis of CRAO using angiography. Additionally this review article is recent within two years. Though the article is very specific to this topic, the Indian journal of ophthalmology has an impact factor of 1.019, which is less than what I would hope for for a research. The first reason this is an acceptable source for wikipedia is it is a review which means it is not a primary resource. Next, the second reason this is an acceptable source is it was published within the 7 years, making it recent enough to use for wikipedia. Finally, the author of this review has published multiple other reviews on ophthalmology topics which have been published in a variety of scientific journals. I believe this provides sufficient evidence for the content in this review to be of a high enough quality to reference on Wikipedia even though the journal that this review was published in has a low impact factor.

Search strategy for resource 2 A search of “central retinal artery occlusion diagnosis on medscape”. I believe this is an appropriate resource because it was last updated in June of 2019, meaning it is recent enough. It is also appropriate to use because it comes from a major medical authority. Lastly, it is a secondary resource, so it is appropriate to use on wikipedia. Citation Findings Hayreh S. S. (2018). Central retinal artery occlusion. Indian journal of ophthalmology, 66(12), 1684–1694. doi:10.4103/ijo.IJO_1446_18 Retinal angiography distinguishes different types of CRAO From this resource I plan to cite explicit information about what can be examined from angiography https://emedicine.medscape.com/article/1223625-workup#c5 A brief overview of the different imaging techniques that are available to be used to diagnose CRAO including fluorescence angiography and fundus autofluorescence From this resource I plan on citing what both fundoscopy and angiography can be used for Diagnosis (OCT/OCTA) - Marcus Citations: OCT: Kapil G. Kapoor, Andrew J. Barkmeier & Sophie J. Bakri (2015) Optical Coherence Tomography in Retinal Arterial Occlusions: Case Series and Review of the Literature, Seminars in Ophthalmology, 30:1, 74-79

OCTA: De Carlo, T. E., Romano, A., Waheed, N. K., & Duker, J. S. (2015). A review of optical coherence tomography angiography (OCTA). International journal of retina and vitreous, 1(1), 5.

Answers to questions: OCT Source Search:

Using PubMed, I conducted a search using the search terms “central retinal artery occlusion” AND “optical coherence tomography”. After the initial search, I further filtered the results with two filters: review articles, and articles published within the last 5 years. After these filters, there were 14 remaining articles. Since OCT is not routinely used in the diagnosis of central retinal artery occlusion, and is also a new technique, there was only 1 article discussing OCT in the context of retinal artery occlusion (the other articles discussed optical coherence tomography angiography, or OCT in the context of acute ischemic retinal whitening). However, this source was a good choice because it discussed a series of cases of CRAO and the different anatomic findings discovered using OCT, which could be helpful in the diagnosis of CRAO. The selected source also meets MEDRS criteria because it is a secondary source, it is recent and thus up to date (published 4 years ago), and it is from a reputable source (Seminars in Opthamology). I plan on using this source to improve the Wikipedia article because it currently contains no information regarding the diagnosis of CRAO, and this source will provide valuable information on new diagnostic techniques.

OCTA Source Search:

Using PubMed, I entered the search terms “central retinal artery occlusion” AND “optical coherence tomography angiography”. After filtering studies to review articles published within the last 5 years, only 13 articles were left. Some sources included “Optical coherence tomography angiography of retinal artery occlusion” and “Optical coherence angiography: A review”. The current study was chosen because it gave a thorough and informative summary of the technology, including an introduction, a comparison to current diagnostic techniques, as well as a discussion on the application of this new technology. This thoroughness and breadth of discussion is what made this source superior to the other ones from the search. This source meets the MEDRS criteria because it is up to date (published in 2015), is a secondary source, and is from a reputable and unbiased source. I plan on using this source to improve the article by adding to the diagnosis section of CRAO, since the current Wikipedia article contains no information regarding diagnostic techniques.

Wikipedia Assignment #3
Current state of Central Retinal Artery Occlusion section for Mechanism: The ophthalmic artery branches off into the central retinal artery which travels with the optic nerve until it enters the eye. This central retinal artery provides nutrients to the retina of the eye, more specifically the inner retina and the surface of the optic nerve.[2] Variations, such as branch retinal artery occlusion, can also occur. Some people have cilioretinal arterial branches, which may or may not be included in the blocked portion.

Proposed Changes: 1) Remove reference used in existing sentences, and use this reference instead. Rationale for proposed change: The citation does not lead to a reference, the new reference states the same understanding of the central retinal artery anatomy and course. There may be disagreement whether to keep the same material with a new reference however this is widely accepted anatomy and therefore I believe it is acceptable to just provide the new reliable reference.

2) Additional sentences to add following the last sentence of "Mechanism" section: Central retinal artery occlusion is most often due to emboli blocking the artery and therefore prevents the artery from delivering nutrients to most of the retina. These emboli originate from the carotid arteries most of the time but in 25% of cases, this is due to plaque build-up in the ophthalmic artery. The most frequent site of blockage is at the most narrow part of the artery which is where the artery pierces the dura covering the optic nerve. . Rationale for proposed change: Though other sections of the article contribute some insight to understanding this component of central retinal artery occlusion, a gap in information was noticed between the discussion of the artery's anatomy and the causes of its occlusion by emboli. These sentences would serve to connect these discussions and provide a more complete picture. There may be variation in the opinion of the frequency that emboli originate within the artery itself but the stated 25% rate will be supported with reliable evidence.

Critique of Source: In both articles, I noticed the potential for selection bias to influence the understanding of the anatomy of the artery and therefore the conclusions of both articles. In my research experience, I have noticed it is commonplace for reference anatomy articles from decades ago, as it seems to be accepted in the community that anatomy does not vary immensely over time. However, the danger with this assumption is that the initial studies that summarized anatomical measurements and landmarks are assumed to be completely correct across the population and over time. Due to publication bias, this may have also lead to the existence of these articles like many that are review articles that summarize new clinical articles and old anatomical articles, because conducting new anatomical studies would not be considered novel and therefore heavily funded or supported. However, these articles were able to combat this in my opinion by referencing articles that use imaging to examine patient's vasculature and therefore providing an indirect view of the anatomy.