Retinal vein occlusion (RVO) is associated with increased risks for stroke, myocardial infarction (MI), and other cardiovascular events, conferring levels of risk beyond traditional factors, a meta-analysis of 15 longitudinal cohort studies has concluded.1
Meanwhile, a separate meta-analysis has found that hypertension doubles the risk of RVO, making it the strongest risk factor for development of an occluded retinal vein.2
CVD in general. Researchers in New York and Hawaii evaluated observational data on 474,466 subjects, 60,069 of whom (12.7%) had RVO. The results showed that the patients with RVO were at greater risk of cardiovascular disease (CVD) and all-cause mortality than their healthy counterparts. Specifically, they had a 45% increased risk of stroke, 26% increased risk of MI, 53% increased risk of heart failure, 26% increased risk of peripheral arterial disease, and 36% increased risk of all-cause mortality.1
The added risks were statistically significant despite adjustment for confounding factors such as age, gender, hypertension, diabetes, and other medical comorbidities, said coauthor Avnish Deobhakta, MD, at the New York Eye and Ear Infirmary of Mount Sinai in New York City.
Previous case series and longitudinal cohort studies that examined the association of RVO with stroke or MI produced inconsistent conclusions, Dr. Deobhakta said. He said he believes the current study settles the issue. “I think the evidence is pretty compelling that RVO is a sentinel event for cardiovascular risks,” Dr. Deobhakta said. “I look at it now as a canary in the coal mine for these other systemic kinds of morbidity-inducing or even life-threatening health risks.”
Hypertension in particular. Researchers in the United Kingdom and China assessed the impact of nine risk factors on the development of any type of RVO. Hypertension proved to be the strongest risk factor, followed by heart attack history, stroke history, and elevated levels of total cholesterol and creatinine.2
Overall, the researchers estimated, the global prevalence of any type of RVO was 0.77% in 2015, equivalent to 23.38 million cases of branch RVO and 6.7 million cases of CRVO. That was up from 16.4 million total cases worldwide of any type of RVO in 2008.
Urgent issue. Once RVO is diagnosed, Dr. Deobhakta suggested, the ophthalmologist should consider urgently referring the patient to a primary care physician for intensive medical management of the person’s cardiovascular risks—and, possibly, should add a strong recommendation for prompt evaluation and follow-up by a cardiologist or neurologist.
“A retinal vein occlusion, by definition, is when a really small vessel in the eye is blocked or there’s some kind of pathology with it. Well, if a really small vessel in the eye is showing that it can be affected in this way, then other vessels can have that kind of problem” as well, Dr. Deobhakta said. “And if we can prevent a stroke or other cardiovascular complication by sending these patients to the right specialists, or getting the right imaging tests, then that would be recommended.”
1 Wu CY et al. Retina. 2019;39(9):1635-1645.
2 Song P et al. J Glob Health. 2019;9(1):010427.
Relevant financial disclosures—Dr. Deobhakta: Alimera Sciences: C; Allergan: C
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Deobhakta Alimera Sciences: C; Allergan: C.
Dr. Etminan None.
Dr. Friedlander None.
Dr. VanderBeek NEI/NIH: S; Paul and Evanina MacKall Foundation: S; Research to Prevent Blindness: S.
||Consultant fee, paid advisory boards, or fees for attending a meeting.
||Employed by a commercial company.
||Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
||Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
||Patents and/or royalties for intellectual property.
||Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies.
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