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  • mRNA Covid-19 Vaccines and RVO Risk

    By Lynda Seminara
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, May 2023

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    Retinal vascular occlusion (RVO) has occurred following mRNA Covid-19 vaccination, but whether the incidence is higher than after influenza or Tdap vaccination is unclear. To learn more, Dorney et al. reviewed health records for several million people who received an mRNA Covid-19 vaccine. They compared RVO incidence among the three types of vaccines and found that the relative risk (RR) of new-onset RVO was not more common with the mRNA vaccine.

    For this work, the authors gathered information from the TriNetX Analyt­ics platform, a federated, aggregated EHR research network, which includes deidentified data for more than 103 million patients. Data for all EHRs in TriNetX were searched for vaccina­tion CPT codes, and the instances of RVO newly diagnosed within 21 days of mRNA vaccination were recorded. Propensity-score matching was per­formed, based on demographics and comorbidities, to assess RR in rela­tion to historical cohorts of patients who received the influenza or Tdap vaccine. The primary outcome was de novo RVO within 21 days after mRNA Covid-19 vaccination.

    Among 3,108,829 patients (mean age, 50.7 years) who received the mRNA Covid-19 vaccine, 104 (0.003%; 95% CI, 0.003%-0.004%) had a new RVO diagnosis in the next 21 days. After propensity-score matching, the risk for new RVO after the first dose of mRNA vaccine did not differ significantly from that after the influenza shot (RR, 0.74; 95% CI, 0.54-1.01) or the Tdap vaccine (RR, 0.78; 95% CI, 0.44-1.38). However, compared with mRNA dose 1, the risk of new-onset RVO was higher after mRNA dose 2 (RR, 2.25; 95% CI, 1.33-3.81).

    The authors concluded that “RVO diagnosed acutely after mRNA Covid- 19 vaccination occurs extremely rarely, at rates similar to those of two dif-ferent historically used vaccinations.” Although they found no link between the mRNA vaccine and new-onset RVO, they affirmed that “detailed research on patients experiencing RVO after vaccination is necessary to eluci­date risk factors for this vision-threat­ening condition.” (Also see related commentary by Lee M. Jampol, MD, and Maureen G. Maguire, PhD, in the same issue.)

    The original article can be found here.