Journal Highlights
JAMA Ophthalmology, December 2023
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The risk of death or cardiovascular events after retinal artery occlusion (RAO) is unclear. Wai et al. looked at the short- and long-term rates of stroke, myocardial infarction (MI), and death following RAO and compared the findings with data for matched controls not affected by RAO. They observed that RAO significantly raised the risk of subsequent death and major vascular events, which was highest shortly after RAO and decreased over time.
For this review, the authors analyzed two decades of electronic health data from the TriNetX network, which contains information on more than 110 million patients. Those with RAO were compared with a control group having cataract, who were matched for age, sex, race, smoking status, and comorbidities. Excluded from the study were individuals with stroke or MI in the two years preceding the diagnosis of RAO or cataract. The main outcome measures were rates of death, stroke, and MI at various time points after the identification of either condition.
Altogether, 34,874 patients were included in the study. Their mean age at the time of RAO diagnosis was 66 years. Relative to controls, the death rate after RAO diagnosis was higher within two weeks (0.14% vs. 0.06%; p < .001), 30 days (0.29% vs. 0.14%; p < .001), one year (3.51% vs. 1.99%; p < .001), five years (22.74% vs. 17.82%; p < .001), and 10 years (57.86% vs. 55.38%; p < .001). The relative risk (RR) values were 2.45, 2.10, 1.78, 1.28, and 1.05, respectively.
Relative to controls, the rate of stroke post-RAO was higher at two weeks (1.72% vs. 0.08%; p < .001), 30 days (2.48% vs. 0.18%; p < .001), one year (5.89% vs. 1.13%; p < .001), five years (10.85% vs. 4.86%; p < .001), and 10 years (14.59% vs. 9.18%; p < .001). The respective RR values were 21.43, 14.8, 5.20, 2.24, and 1.59. Moreover, MI rates after RAO were higher at two weeks (0.16% vs. 0.06%; p < .001), 30 days (0.27% vs. 0.10%; p < .001), one year (1.66% vs. 0.97%; p < .001), five years (6.06% vs. 5.00%; p < .001), and 10 years (10.55% vs. 9.43%; p = .003). The corresponding RR values for MI were 3.00, 2.61, 1.72, 1.21, and 1.12.
The authors emphasized that RAO may be a sign of systemic disease or major cardiovascular events, which can occur weeks, months, or years later. Hence, they support multidisciplinary evaluation and long-term follow-up of patients who experience RAO. Further studies are needed to optimize the triage system following RAO, they said.
The original article can be found here.