Purpose To quantify optical coherence tomography (OCT)-derived retinal layer reflectivity and retinal thickness changes in acute central retinal artery occlusion (CRAO) for rapid diagnosis and stratification of ischemic tissue state, referenced to the clinically relevant 4.5-h window for reperfusion therapies. Methods This retrospective multicenter study included 39 patients with unilateral acute non-arteritic CRAO imaged by OCT within 48 h of reliably reported symptom onset. Five horizontal mac