Retinal Artery Occlusion and Its Impact on the Incidence of Stroke, Myocardial Infarction, and All-Cause Mortality during 12-Year Follow-Up

Abstract

The aim of the study was to evaluate the incidence of ischemic stroke, myocardial infarction, and all-cause mortality in patients with retinal artery occlusion (RAO). This single-center retrospective study included 139 patients diagnosed with RAO between 2009 and 2020. The control group included 139 age- and sex-matched patients without RAO who underwent cataract surgery. The year of the surgery corresponded to the year of RAO onset. During the 12-year follow-up, patients with RAO had a shorter time to death (49.95 vs. 15.74 months; p = 0.043), a higher all-cause mortality rate (log-rank p = 0.026, and a higher rate of the composite endpoint, including ischemic stroke, myocardial infarction, and all-cause mortality (log-rank p = 0.024), as compared with controls. Patients with RAO younger than 75 years showed a higher risk of cerebral ischemic stroke (log-rank p = 0.008), all-cause mortality (log-rank p = 0.023), and the composite endpoint (log-rank p = 0.001) than controls. However, these associations were not demonstrated for patients aged 75 years or older. Our study confirms that patients with RAO have a higher risk of all-cause mortality than those without RAO. Moreover, patients with RAO who are younger than 75 years are significantly more likely to experience ischemic stroke, death, or the composite endpoint after an occlusion event, as compared with individuals without RAO.

Retinal artery occlusion and its association with stroke – literature review

“…Another 12-year retrospective study on the European population showed that RAO patients who are younger than 75 years are significantly more likely to experience ischemic stroke after an occlusion event, as compared with individuals without RAO [7]. However, these associations were not demonstrated for patients aged 75 years or older [7].…”

“…The studies differ in the number of people included in the study. We have studies based on a small study group [3,4,6,7,15,16,20,24,31,37] as well as studies based on large databases compiled on the basis of analyzing the International Classification of Diseases (ICD) codes [5, 9-12, 17, 18, 21, 36]. Recently, the results obtained from the analysis of large databases created with the use of ICD codes have been questioned [31].…”

“…Recently, the results obtained from the analysis of large databases created with the use of ICD codes have been questioned [31]. Individual studies have a control group appropriately selected in terms of sex and age, or comorbidities [5,7,9,10,12]. Studies also differ in the duration of follow-up, ranging from a few days to several years [3-21, 24, 31].…”

“…Most cases of RAO have non-arteritic etiology, the main cause of which is embolism originating from the ipsilateral carotid artery, heart or aortic arch [1,2]. Patients with RAO are burdened with numerous, often undiagnosed cardiovascular risk factors, including arterial hypertension, diabetes, obesity, hyperlipidemia, nicotinism, and chronic kidney disease [1][2][3][4][5][6][7][8]. The etiology of RAO and the profile of risk factors found in patients with RAO are comparable to those of patients with ischemic stroke.…”

Risk Factors and Treatment Strategy for Retinal Vascular Occlusive Diseases

“…As most patients with retinal artery occlusion do not receive examinations necessary for cardiovascular testing [ 58 ], healthcare providers must always be aware that the detection of these serious diseases can prevent the occurrence of subsequent stroke and cardiovascular diseases. In fact, patients with retinal artery occlusion have a shorter life expectancy and higher risk of all-cause mortality [ 59 ].…”