Central retinal artery occlusion is a devastating vascular complication producing an ischemic injury in the layers of the retina in which natural history may impose a poor visual prognosis for patients suffering from this condition.^{Reference Hayreh and Zimmerman1} The article “CRAO experience in an Academic Canadian Centre” by Quinn et al.^{Reference Quinn, Liu, Albreiki and Lelli2} demonstrates the difficulties recognizing this syndrome by patients, late admission to hospital, delay in specialist assessment, delay in potential treatment and delay in interdisciplinary network. A series of cases have suggested that an early aggressive thrombolytic treatment may change the natural prognosis of the disease.^{Reference Beatty and Au-Fong3} Randomized clinical trials have failed to demonstrate improvement with either intravenous or intraarterial thrombolysis.^{Reference Chen, Lee and Campbell4,Reference Schumacher, Schmidt and Jurklies5} The time window from the onset of symptoms to treatment in these trials was around 14 and 12 hours, respectively. Animal studies have shown that the inner nuclear and ganglion cell layer of the retina are the most vulnerable group of cells for this ischemic injury, and the time required for reperfusion was around 4 hours, with the best prognosis within 2 hours from onset mismatching the time achieved in clinical trials.^{Reference Hayreh, Zimmerman, Kimura and Sanon6}

There is a national need to create an online ocular stroke network, including 24/7 ophthalmologist/retinologist and thrombolytic centers across the country (primary and comprehensive stroke centers) for the prompt recognition and diagnosis of this entity, and the need of a national clinical trial evaluating the impact in prognosis of a new theoretical best window for thrombolysis within 4 hours from the onset of symptoms. If retinal cells are dying as neurons, then thrombolysis should be set up as a stroke window.