Increased Risk of Death, Stroke After Retinal Artery Occlusions

Higher risks of death, stroke, and myocardial infarction (MI) were found in patients who had retinal artery occlusions (RAOs) compared with a control population of patients with cataracts, according to a study published in JAMA Ophthalmology. Patients should be followed up after RAO given these results, the authors emphasize.

RAOs can cause sudden vision loss but are relatively rare, with an incidence of 1.3 to 1.8 per 100,000 person-years (PYs) for central RAOs and 5.12 per 100,000 PYs for noncentral RAOs. No proven therapy exists for vision loss due to RAOs, and management consists of preventing further complications. Understanding the risk of complications, including secondary vascular events, could help clinicians better manage patients with RAOs. This study aimed to evaluate the risk of death and other vascular events after RAOs compared with other patients with cataracts.

The researchers used TriNetX, which collects data from around the world and the United States. The data were collected on April 14, 2023, and covered January 1, 2003, through to April 14, 2023. Codes from the International Statistical Classification of Disease and Related Health Problems, 10th Revision were used to identify patients with RAOs and cataracts. Demographics were collected at baseline, and they included race, sex, and age at event.

There were 34,874 patients in the RAOs cohort who had at least 1 year of follow-up. The mean (SD) age of the patients at their RAO event was 66 (15.2) years. Twenty-four percent of patients had central RAOs, 35% had transient RAOs, and 42% had other RAOs.

Close up view of beautiful blue female eye | Image credit: Liudmila Dutko - stock.adobe.com

The rate of death in patients was 0.14% after 2 weeks, 0.29% after 30 days, and 3.51% after 1 year; the risks of stroke were 1.72%, 2.48%, and 5.88%, respectively; and the risks of MI were 0.16%, 0.27%, and 1.66%. There was a high risk of comorbid outcomes due to RAOs events, with a 22.7% risk of death, 10.86% risk of stroke, and 6.06% risk of MI after 5 years. These increased to 57.86%, 14.59%, and 10.55%, respectively, after 10 years.

There were 34,552 patients for both the RAOs cohort and cataract control cohort after matching for age, sex, race, and systemic associations. The rate of death after RAOs was higher compared with after cataract diagnosis after 2 weeks (0.14% vs 0.06%; relative risk [RR], 2.45; 95% CI, 1.46-4.12), 30 days (0.29% vs 0.14%; RR, 2.10; 95% CI, 1.49-2.97), and 1 year (3.51% vs 1.99%; RR, 1.78; 95% CI, 1.61-1.94).

The risk of stroke was also higher among patients in the RAOs cohort after 2 weeks (1.72% vs 0.08%; RR, 21.43; 95% CI, 14.67-31.29), 30 days (2.48% vs 0.18%; RR, 14.18; 95% CI, 10.94-18.48), and 1 year (5.89% vs 1.13%; RR, 5.20; 95% CI, 4.67-5.79). Further, risk of MI was higher in the RAOs cohort after 2 weeks (0.16% vs 0.06%; RR, 3.00; 95% CI, 1.79-5.04), 30 days (0.27% vs 0.10%; RR, 2.61; 95% CI, 1.78-3.83), and 1 year (1.66% vs 0.97%; RR, 1.72; 95% CI, 1.51-1.97).

There were some limitations to this study. It relied on accurate coding for diagnoses, which does not account for potential misclassification and does not exclude those with asymptomatic RAOs. Also, confounding factors for whether cataracts could affect RAO risk were possible due to using cataracts as the control diagnosis.

The researchers concluded that there was an increased risk of death, stroke, and MI in patients who had RAOs, both short term and long term, but that the relative risk was still low. Further studies need to evaluate how best to triage patients with RAOs for management of treatment.

Reference

Wai KM, Knapp A, Ludwig CA, et al. Risk of stroke, myocardial infarction, and death after retinal artery occlusion. JAMA Ophthalmol. Published online October 26, 2023. doi:10.1001/jamaophthalmol.2023.4716