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In response to the bodys inability to provide sufficient oxygen and nutrients to the retina, a localized increase in blood flow is often seen, which can result in additional damage through increased shear stress on vessels.Citation 20 When increased localized blood flow is not enough to meet the oxygen demands of retinal tissue, DNA-binding proteins known as Hypoxia Inducible Factors (HIFs) are stabilized

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The most common themes to emerge were that 1) The patient did not feel ready or that they were contacted at a bad time (n= 6) and 2) At the time of referral, the patient was documented to have altered mental status either from their current medical condition or dementia (n=4)

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