Abstract
Retinal vascular events are perceived to be related to various cardiovascular complications. We conducted a systematic review to assess the relationship between retinal artery/vein occlusions (RAO/RVO) and the incidence of mortality, stroke, and myocardial infarction (MI). A comprehensive electronic literature search selected 93 relevant studies between 1992–2015: 16 articles qualified for inclusion (7 for mortality rate and MI, 11 for stroke). No published articles examined associations of RAO to mortality or MI, but only to stroke. Because of the heterogeneity of studies, no meta-analysis was performed. The association with mortality risk was highest at ~34.7% in RVO subgroup; whereas for MI, the risk was comparatively lower at 3.9–5.7% for RVO. There was no significant difference in stroke rate when comparing central and branch RVO subgroups (6.5%), but was significantly higher at 19.6–25% in RAO. There is a positive association of retinal vascular events to mortality, stroke, and MI. RAO is associated with a higher risk of stroke. Given that RAO and RVO patients would generally present to ophthalmologists, their high cardiovascular risk should include a referral for cardiovascular assessment as part of their management protocol.
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References
Cheung N, Klein R, Wang JJ, Cotch MF, Islam AF, Klein BE et al. Traditional and novel cardiovascular risk factors for retinal vein occlusion: the multiethnic study of atherosclerosis. Invest Ophthalmol Vis Sci 2008; 49 (10): 4297–4302.
Klein R, Klein BE, Moss SE, Meuer SM . The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc 2000; 98: 133–141.
Rogers SL, McIntosh RL, Lim L, Mitchell P, Cheung N, Kowalski JW et al. Natural history of branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology 2010; 117 (6): 1094–1101.
Shih C-H, Ou S-Y, Shih C-J, Chen Y-T, Ou S-M, Lee Y-J . Bidirectional association between the risk of comorbidities and the diagnosis of retinal vein occlusion in an elderly population: A nationwide population-based study. Int J Cardiol 2015; 178: 256–261.
Bertelsen M, Linneberg A, Christoffersen N, Vorum H, Gade E, Larsen M . Mortality in patients with central retinal vein occlusion. Ophthalmology 2014; 121 (3): 637–642.
Xu L, Liu WW, Wang YX, Yang H, Jonas JB . Retinal vein occlusions and mortality: the Beijing Eye Study. Am J Ophthalmol 2007; 144 (6): 972–973.
Tsaloumas MD, Kirwan J, Vinall H, O’Leary MB, Prior P, Kritzinger EE et al. Nine year follow-up study of morbidity and mortality in retinal vein occlusion. Eye (Lond) 2000; 14 (Pt 6): 821–827.
Mansour AM, Walsh JB, Henkind P . Mortality and morbidity in patients with central retinal vein occlusion. Ophthalmologica 1992; 204 (4): 199–203.
Christoffersen N, Gade E, Knudsen L, Juel K, Larsen M . Mortality in patients with branch retinal vein occlusion. Ophthalmology 2007; 114 (6): 1186–1189.
Werther W, Chu L, Holekamp N, Do D V, Rubio RG . Myocardial infarction and cerebrovascular accident in patients with retinal vein occlusion. Arch Ophthalmol 2011; 129 (3): 326–331.
Di Capua M, Di Minno MND, Guida A, Loffredo M, Cuccaro C, Coppola A et al. Coronary artery disease, cerebral non-fatal ischemic stroke in retinal vein occlusion: an 8-yr follow-up. Nutr Metab Cardiovasc Dis 2012; 22 (1): 23–27.
Rim TH, Kim DW, Han JS, Chung EJ . Retinal vein occlusion and the risk of stroke development. Ophthalmology 2015; 122 (6): 1187–1194.
Christiansen CB, Lip GYH, Lamberts M, Gislason G, Torp-Pedersen C, Olesen JB . Retinal vein and artery occlusions: a risk factor for stroke in atrial fibrillation. J Thromb Haemost 2013; 11 (8): 1485–1492.
Ho J, Liou S . Retinal vein occlusion and the risk of stroke development: a five-year follow-up study. Am J Ophthalmol 2009; 147 (2): 283–290.
Chang Y-S, Jan R-L, Weng S-F, Wang J-J, Chio C-C, Wei F-T et al. Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study. Am J Ophthalmol 2012; 154 (4): 645–652.e1.
Ueda Y, Kanazawa S, Ohira A, Miyamura N, Takaki T, Kitaoka T et al. Retinal vascular obstruction and asymptomatic cerebral infarction. Jpn J Ophthalmol 2002; 46 (2): 209–214.
Bertelsen M, Linneberg A, Rosenberg T, Christoffersen N, Vorum H, Gade E et al. Comorbidity in patients with branch retinal vein occlusion: case-control study. BMJ 2012; 345: e7885.
Hu C-C, Ho J-D, Lin H-C . Retinal vein occlusion and the risk of acute myocardial infarction (correction of infraction): a 3-year follow-up study. Br J Ophthalmol 2009; 93 (6): 717–720.
Kuo JZ, Lai CC, Ong FS, Shih CP, Yeung L, Chen TL et al. Central retinal vein occlusion in a young Chinese population: risk factors and associated morbidity and mortality. Retina 2010; 30 (3): 479–484.
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GYHL is consultant for Bayer/Jansen J&J, BMS/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim and Daiichi-Sankyo; speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi-Sankyo. The remaining authors declare no conflict of interest.
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Woo, S., Lip, G. & Lip, P. Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review. Eye 30, 1031–1038 (2016). https://doi.org/10.1038/eye.2016.111
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DOI: https://doi.org/10.1038/eye.2016.111
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