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  • COVID-19, flu, and Tdap share similar, very low post-vaccination RVO risk

    Comprehensive Ophthalmology, Retina/Vitreous

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    Review of: Risk of new retinal vascular occlusion after mRNA COVID-19 vaccination within aggregated electronic health record data

    Dorney I, Shaia J, Kaelber D, et al. JAMA Ophthalmology, May 2023

    In an analysis of data from more than 3.1 million patients who received the mRNA COVID-19 vaccination, very few patients developed retinal vein occlusion (RVO), with the relative risk of RVO within 21 days of COVID-19 vaccination no different than that seen after influenza or Tdap vaccinations.

    Study design

    This was a retrospective cohort analysis of an electronic health record network that included data from more than 100 million patients. Rates of RVO within 21 days after the mRNA COVID-19 vaccine were compared to RVO rates after receiving other common vaccines using historical data.

    Outcomes

    Of the more 3,108,829 patients who received a first dose of the mRNA COVID-19 vaccine, 104 (0.003%) had a new diagnosis of RVO within 21 days of vaccination. The relative risk (RR) for new RVO diagnosis after the first dose of COVID-19 vaccination was not significantly different from the risk seen after receiving influenza (RR 0.74) or Tdap (RR 0.78) vaccinations, but it was greater than the risk after a second COVID-19 vaccination after propensity score matching (RR 2.25). The relative risk for a new RVO diagnosis after COVID-19 infection was 4.25 times higher than after COVID-19 vaccination.

    Limitations

    All cohort studies of large databases are limited by the accuracy of coding diagnoses.

    Clinical significance

    Based on the data from this study, we can reassure patients that the risk of developing a post-vaccination RVO is no different between the mRNA COVID-19 vaccine and other common vaccines. Furthermore, the risk of developing an RVO after COVID-19 infection is higher than after receiving the mRNA COVID-19 vaccine.

    Financial Disclosures: Dr. Ajay Kuriyan discloses financial relationships with Adverum, Annexon, National Eye Institute (Grant Support); Alimera Sciences, Allergan, Bausch + Lomb, EyePoint Pharmaceuticals, Novartis, Alcon Pharmaceuticals (Consultant/Advisor); Optos (Lecture Fees/Speakers Bureau); Lumata Health, Recens Medical (Consultant/Advisor, Private Equity/Stock Holder); Spark Therapeutics (Consultant/Advisor, Lecture Fees/Speakers Bureau); Genentech (Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support).