Risk of New Retinal Vascular Occlusion After mRNA COVID-19 Vaccination Within Aggregated Electronic Health Record Data

Abstract

ImportanceNew-onset retinal vascular occlusion (RVO) occurring acutely after messenger RNA (mRNA) COVID-19 vaccination has been described in recent literature. Because RVO can cause vision loss or blindness, an epidemiologic investigation evaluating this potential association is of great importance to public health.ObjectiveTo investigate how often patients are diagnosed with new RVO acutely after the mRNA COVID-19 vaccine compared with influenza and tetanus, diphtheria, pertussis (Tdap) vaccines.Design, Setting, and ParticipantsA retrospective population-based cohort design using the TriNetX Analytics platform, a federated, aggregated electronic health record (EHR) research network containing the deidentified EHR data of more than 103 million patients, was used to examine aggregate EHR data. Data were collected and analyzed on October 20, 2022. Data on patients within the TriNetX Analytics platform were searched for the presence of vaccination Common Procedural Technology codes, and instances of newly diagnosed RVO within 21 days of vaccination were recorded and reported. Propensity score matching based on demographic characteristics (age, sex, race and ethnicity) and comorbidities (diabetes, hypertension, and hyperlipidemia) was performed between vaccination groups for evaluation of relative risks (RRs).Main Outcomes and MeasuresThe appearance of a new-encounter diagnosis of RVO within 21 days of the mRNA COVID-19 vaccination was the primary outcome. Historical comparison cohorts of patients receiving influenza and Tdap vaccinations allowed for evaluation of the RRs for RVO.ResultsOf 3 108 829 patients (mean [SD] age at vaccination, 50.7 [20.4] years; 56.4% women) who received the mRNA COVID-19 vaccine, 104 (0.003%; 95% CI, 0.003%-0.004%) patients had a new diagnosis of RVO within 21 days of vaccination. After propensity score matching, the RR for new RVO diagnosis after the first dose of COVID-19 vaccination was not significantly different from that after influenza (RR, 0.74; 95% CI, 0.54-1.01) or Tdap (RR, 0.78; 95% CI, 0.44-1.38) vaccinations, but was greater when compared with the second dose of the COVID-19 vaccination (RR, 2.25; 95% CI, 1.33-3.81).Conclusions and RelevanceThe findings of this study suggest that RVO diagnosed acutely after mRNA COVID-19 vaccination occurs extremely rarely at rates similar to those of 2 different historically used vaccinations, the influenza and Tdap vaccines. No evidence suggesting an association between the mRNA COVID-19 vaccination and newly diagnosed RVO was found.

No Red Flags for Risk of Retinal Vascular Occlusion After mRNA COVID-19 Vaccination

“…Without a comparable group of people without mRNA COVID-19 vaccination, it is difficult to rule out an association between mRNA COVID-19 vaccination and retinal vascular occlusion based on the results provided by Dorney and coworkers. 3 Nonetheless, the very low incidence is noteworthy. However, these results for mRNA vaccines are not applicable to other COVID-19 vaccines, such as viral vector and protein subunit vaccines, which could have different results.…”

“…Dorney and coauthors 3 have attempted to evaluate the retinal vascular occlusion risk associated with mRNA COVID-19 vaccination using aggregated electronic health record data. Retinal vascular occlusions are, in general, relatively rare, with an annual incidence of 150 per 100 000 4 people, and the predominant type is branch retinal vein occlusion.…”

“…Without a comparable group of people without mRNA COVID-19 vaccination, it is difficult to rule out an association between mRNA COVID-19 vaccination and retinal vascular occlusion based on the results provided by Dorney and coworkers . Nonetheless, the very low incidence is noteworthy.…”

Risk of New Retinal Vascular Occlusion After Messenger RNA COVID-19 Vaccination Within Aggregated Electronic Health Record Data

“…One difference between the Dorney et al study and previous studies may be associated with the method of data collection. Their study assessed RVO occurrence at a biweekly interval up to 12 weeks and then at 2 years.…”

“…In addition, it is important to note that COVID-19 infections have been previously associated with RVOs . Furthermore, the Dorney et al study collected data between 2020 and 2022, which was after the COVID-19 epidemic started in 2019. This time period might have been more ideal to detect RVOs due to the increased availability of COVID-19 screening tests, which allowed their study to exclude COVID-19 infections by identifying those who tested positive for polymerase chain reaction or immunoassay results from the TriNetX database, potentially increasing the validity of these findings.…”