Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Comparative effectiveness of varying hyperbaric oxygen protocols in the treatment of acute central retinal artery occlusion

Eye (2026)Cite this article

Subjects

Abstract

Background

The comparative effectiveness of different hyperbaric oxygen (HBO) therapy doses in the acute treatment of central retinal artery occlusion (CRAO) has not been evaluated.

Methods

This retrospective cohort study aimed to compare the efficacy of an initial 2.8ATA HBO session (HBO18) to the more prevalent 2.0ATA protocol (HBO10). Excluded were patients with suspected inflammatory arteritis or branch retinal artery occlusion, and when HBO was medically contraindicated. Following the initial session, all patients completed two additional HBO10 sessions within 24 h. The primary outcome was the change in best corrected visual acuity (ΔBCVA) within 24 ± 4 h. Safety outcomes included neurological events suggestive of central oxygen toxicity and barotrauma-related symptoms.

Results

Improvement in ΔBCVA was significantly greater in the HBO18 group (median 0.62 LogMAR, mean −0.81 ± 0.73) compared with the HBO10 group (median 0.22 LogMAR, mean −0.34 ± 0.40, p < 0.001). Adverse events were similar in incidence between the treatment groups, with no severe occurrences necessitating the discontinuation of HBO reported. In multivariate analysis, HBO18 use was associated with a 0.5 LogMAR improvement in BCVA at 24 h (95% CI 0.3–0.7, p < 0.001), with greater initial BCVA impairment and shorter time to HBO further associated with better outcomes (0.20 LogMAR, 95% CI 0.08–0.31, p = 0.001; and 0.04 LogMAR/hour, 95% CI 0.02–0.04, p = 0.01, respectively).

Conclusions

HBO18 as the initial therapy for CRAO seems to be associated with better short-term improvement in BCVA, compared with HBO10.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Patient selection.
Fig. 2: Visual Acuity upon presentation and Primary Outcome.

Similar content being viewed by others

Data availability

Full unidentified data is available upon request at ostyly@gmail.com.

References

  1. Cope A, Eggert JV, O’Brien E. Retinal artery occlusion: visual outcome after treatment with hyperbaric oxygen. Diving Hyperb Med. 2011;41:135–8.

    PubMed  Google Scholar 

  2. Mac Grory B, Nackenoff A, Poli S, Spitzer MS, Nedelmann M, Guillon B, et al. Intravenous fibrinolysis for central retinal artery occlusion: a cohort study and updated patient-level meta-analysis. Stroke. 2020;51:2018–25.

    Article  Google Scholar 

  3. Beiran I, Reissman P, Scharf J, Nahum Z, Miller B. Hyperbaric oxygenation combined with nifedipine treatment for recent-onset retinal artery occlusion. Eur J Ophthalmol. 1993;3:89–94.

    Article  CAS  PubMed  Google Scholar 

  4. Schmidt I, Walter P, Siekmann U, Plange N, Koutsonas A, Mazinani BE, et al. Development of visual acuity under hyperbaric oxygen treatment (HBO) in non arteritic retinal branch artery occlusion. Graefes Arch Clin Exp Ophthalmol. 2020;258:303–10.

    Article  CAS  PubMed  Google Scholar 

  5. Beiran I, Goldenberg I, Adir Y, Tamir A, Shupak A, Miller B. Early hyperbaric oxygen therapy for retinal artery occlusion. Eur J Ophthalmol. 2001;11:345–50.

    Article  CAS  PubMed  Google Scholar 

  6. Rosignoli L, Chu ER, Carter JE, Johnson DA, Sohn J-H, Bahadorani S. The effects of hyperbaric oxygen therapy in patients with central retinal artery occlusion: a retrospective study, systematic review, and meta-analysis. Korean J Ophthalmol. 2022;36:108–13.

    Article  CAS  PubMed  Google Scholar 

  7. Lopes AS, Basto R, Henriques S, Colaço L, Costa E, Silva F, et al. Hyperbaric oxygen therapy in retinal arterial occlusion: epidemiology, clinical approach, and visual outcomes. Case Rep Ophthalmol Med. 2019;2019:9765938.

    PubMed  PubMed Central  Google Scholar 

  8. Lee JM, Choi SH, Jeon GS, Chang IB, Wang SJ, Hong IH. A comprehensive evaluation of efficacy of hyperbaric oxygen therapy in non-arteritic central retinal artery occlusion using enhanced depth imaging optical coherence tomography. Sci Rep. 2024;14:23676.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kim BM, Wang KY, Xu TT, Hooshmand SJ, Toups GN, Millman MP, et al. Outcomes of hyperbaric oxygen treatment for central retinal artery occlusion: a single center experience. Am J Ophthalmol. 2025;269:393–401.

    Article  CAS  PubMed  Google Scholar 

  10. Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, et al. Retinal and ophthalmic artery occlusions preferred practice pattern®. Ophthalmology. 2020;127:P259–87.

    Article  PubMed  Google Scholar 

  11. Bailey IL, Lovie-Kitchin JE. Visual acuity testing from the laboratory to the clinic. Vision Res. 2013;90:2–9.

    Article  PubMed  Google Scholar 

  12. Moussa G, Bassilious K, Mathews N. A novel excel sheet conversion tool from Snellen fraction to LogMAR including “counting fingers”, “hand movement”, “light perception” and “no light perception” and focused review of literature of low visual acuity reference values. Acta Ophthalmol. 2021;99:e963–5.

    Article  PubMed  Google Scholar 

  13. Chen J-M, Lu Z-N, Wu R-W, Bi K-W, Liu C-T. Effect of self-acupressure on middle ear barotrauma associated with hyperbaric oxygen therapy: a nonrandomized clinical trial. Medicine (Baltimore). 2021;100:e25674.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Williamson J, Sharma A, Murray-Douglass A, Peters M, Lee L, Webb R, et al. Outcomes of hyperbaric oxygen treatment for central and branch retinal artery occlusion at a major Australian referral hospital. Diving Hyperb Med. 2023;53:224–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Churchill S, Deru K, Wilson G, Cable R, Bell JE, Weaver LK. Rates of visual acuity change in patients receiving hyperbaric oxygen in monoplace and multiplace chambers. Undersea Hyperb Med. 2016;43:217–23.

    PubMed  Google Scholar 

  16. Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol. 2005;140:376–91.

    Article  PubMed  Google Scholar 

  17. Schorr EM, Rossi KC, Stein LK, Park BL, Tuhrim S, Dhamoon MS. Characteristics and outcomes of retinal artery occlusion: nationally representative data. Stroke. 2020;51:800–7.

    Article  PubMed  Google Scholar 

  18. Rozenberg A, Hadad A, Peled A, Dubinsky-Pertzov B, Or L, Eting E, et al. Hyperbaric oxygen treatment for non-arteritic central retinal artery occlusion retrospective comparative analysis from two tertiary medical centres. Eye. 2022;36:1261–5.

    Article  CAS  PubMed  Google Scholar 

  19. Elder MJ, Rawstron JA, Davis M. Hyperbaric oxygen in the treatment of acute retinal artery occlusion. Diving Hyperb Med. 2017;47:233–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Beiran I, Rimon I, Weiss G, Pikkel J, Miller B. Hyperbaric oxygenation therapy for ischemic optic neuropathy. Eur J Ophthalmol. 1995;5:285–6.

    Article  CAS  PubMed  Google Scholar 

  21. Di Vincenzo H, Kauert A, Martiano D, Chiabo J, Di Vincenzo D, Sozonoff I, et al. Efficacy and safety of a standardized hyperbaric oxygen therapy protocol for retinal artery occlusion. Undersea Hyperb Med. 2022;49:495–505.

    Article  PubMed  Google Scholar 

  22. Chiabo J, Kauert A, Casolla B, Contenti J, Nahon-Esteve S, Baillif S, et al. Efficacy and safety of hyperbaric oxygen therapy monitored by fluorescein angiography in patients with retinal artery occlusion. Br J Ophthalmol. 2023;108:956–62.

Download references

Funding

The article publishing costs of this study were funded by the Ofakim fund (RMC, Haifa, Israel. Grant number 4326).

Author information

Authors and Affiliations

  1. School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel

    Ivan Gur & Yuval Nov

  2. Department of Internal Medicine C, Rambam Health Care Campus, Haifa, Israel

    Ivan Gur

  3. Department of Ophthalmology, Hillel Yaffe Medical Center, Hadera, Israel

    Inbar Gur

  4. School of Medicine, Hebrew University in Jerusalem, Jerusalem, Israel

    Michael Gitzman

  5. The Azrieli Faculty of Medicine, Bar Ilan University, Zfat, Israel

    Leah Atal

  6. Department of Pediatric Neurology and Developmental Medicine, Carmel Medical Center, Haifa, Israel

    Yinnon Matsliah

  7. Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel

    Elie Zaher & Nitsan Duvdevan-Strier

  8. The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

    Nitsan Duvdevan-Strier

Authors
  1. Ivan Gur
    View author publications

    Search author on:PubMed Google Scholar

  2. Inbar Gur
    View author publications

    Search author on:PubMed Google Scholar

  3. Michael Gitzman
    View author publications

    Search author on:PubMed Google Scholar

  4. Leah Atal
    View author publications

    Search author on:PubMed Google Scholar

  5. Yinnon Matsliah
    View author publications

    Search author on:PubMed Google Scholar

  6. Elie Zaher
    View author publications

    Search author on:PubMed Google Scholar

  7. Nitsan Duvdevan-Strier
    View author publications

    Search author on:PubMed Google Scholar

  8. Yuval Nov
    View author publications

    Search author on:PubMed Google Scholar

Contributions

IG, IG, and YM conceptualised this study. IG, LA and MG reviewed the health records of all patients involved and compiled the database. IG and YN performed the statistical analysis. IG, EZ and NDS contributed their invaluable clinical expertise guiding the analysis performed. IG wrote the initial draft of this manuscript. All authors participated in the writing of this paper and approved the final version of this manuscript.

Corresponding author

Correspondence to Ivan Gur.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics and other permissions

This study was performed in accordance with the Declaration of Helsinki. This human study was approved by Rambam Health Care Ethics Committee - approval: RMB-22-0398. The requirement for informed consent was waived due to the purely observational nature of this study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gur, I., Gur, I., Gitzman, M. et al. Comparative effectiveness of varying hyperbaric oxygen protocols in the treatment of acute central retinal artery occlusion. Eye (2026). https://doi.org/10.1038/s41433-026-04298-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41433-026-04298-3

Search

Advanced search

Quick links