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  • Stroke Risk Soars After RAO

    By Lynda Seminara
    Selected By: Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Eye
    Published online April 28, 2021

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    Based on mounting evidence of a relationship between stroke and retinal artery occlusion (RAO), the American Heart Association recommends imme­diate assessment for any patient with RAO or amaurosis fugax. Although the Academy has adopted these guidelines, fewer ophthalmologists than neurol­ogists are likely to recommend urgent workup for patients with RAO. Scoles et al. assessed the near-term risk of stroke after RAO and found that stroke risk was highest in the days following central or branch RAO.

    For this matched-case series, the authors used a large health care claims database and estimated stroke risk for two cohorts: 1) a self-controlled case series (SCCS; n = 16,193) and 2) a co­hort matched by propensity score (PS; n = 18,213 with RAO but no previous stroke matched with 18,213 patients with hip fracture). All participants were 55 years of age or older. The date of RAO diagnosis was considered the in­dex date. In the SCCS, stroke incidence was compared for periods before and after the index date. Primary outcome measures were the occurrence of stroke and its timing relative to the index date. Cox proportional regression was applied to determine the hazard ratios for stroke.

    RAO raised the risk of stroke in both groups. In the SCCS, the incidence rate ratio of stroke was significantly higher within 30 days after RAO diagnosis than in periods more than two months before RAO (p < .012). In the PS-matched cohort, the hazard ratio for stroke was nearly 3 times greater after central or branch RAO than after hip fracture (p < .001).

    An unexpected finding of this study was the large number of first strokes occurring shortly before RAO diag­nosis. A possible explanation, said the authors, is that a danger period exists in which any embolic phenomenon can occur. Whether or not this proves to be the case, they stressed the importance of promptly referring patients with RAO for a full workup to include stroke evaluation.

    The original article can be found here.