Stroke is a leading cause of mortality and morbidity. Thus, identifying associated risk factors may lead to earlier interventions aimed at reducing the risk of stroke development. Since cardiovascular disease simultaneously increases the risk of stroke and retinal vein occlusion (RVO), we sought to determine whether RVO is associated with the risk of stroke independent of underlying cardiovascular co-morbidities.
In this cross-sectional study, we reviewed the records of 80,754 individuals who were evaluated by an ophthalmologist over a 6-year period. We identified individuals with RVO, stroke and cardiovascular diseases including hypertension, diabetes mellitus, carotid disease, coronary artery disease and atrial fibrillation. Multivariable logistic regression models were used to analyze odds ratios for RVO and stroke.
After adjusting for age, sex, cardiovascular disease and other risk factors, we found that the presence of RVO was associated with an odds ratio for stroke of 1.73 (CI, 1.40–2.12, p < 0.001). The association between RVO and stroke, after adjusting for sex and cardiovascular co-morbidities, was significantly stronger in individuals younger than 50 years of age, with an odds ratio of having a stroke of 3.06 (1.34–6.25, p < 0.001), while the presence of RVO in individuals older than 85 years was not significantly associated with stroke 1.19 (0.77–1.79, p = 0.41).
Our findings demonstrate that RVO is significantly associated with stroke, even after adjusting for underlying cardiovascular co-morbidities. This association was highly significant in younger subjects, while not significant in older individuals.
This is a preview of subscription content, access via your institution
Open Access articles citing this article.
Risk analysis for patients with arterial thromboembolic events after intravitreal ranibizumab or aflibercept injections
Scientific Reports Open Access 10 May 2023
Subscribe to this journal
Receive 18 print issues and online access
$259.00 per year
only $14.39 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
The datasets analyzed during the current study are available from the corresponding author on reasonable request.
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: a report from the American Heart Association. Circulation. 2019;139:e56–e528.
Bakhoum MF, Freund KB, Dolz-Marco R, Leong BCS, Baumal CR, Duker JS, et al. Paracentral acute middle maculopathy and the ischemic cascade associated with retinal vascular occlusion. Am J Ophthalmol. 2018;195:143–53.
Chan AX, Bakhoum CY, Bangen KJ, Bakhoum MF. The relationship between retinal vascular occlusions and cognitive dementia in a large cross-sectional cohort. Am J Ophthalmol. 2021;226:201–5.
Long CP, Chan AX, Bakhoum CY, Toomey CB, Madala S, Garg AK, et al. Prevalence of subclinical retinal ischemia in patients with cardiovascular disease – a hypothesis driven study. EClinicalMedicine. 2021;33:100775.
Wu CY, Riangwiwat T, Limpruttidham N, Rattanawong P, Rosen RB, Deobhakta A. Association of retinal vein occlusion with cardiovascular events and mortality: a systematic review and meta-analysis. Retina. 2019;39:1635–45.
Scott IU, Campochiaro PA, Newman NJ, Biousse V. Retinal vascular occlusions. Lancet. 2020;396:1927–40.
Mir TA, Arham AZ, Fang W, Alqahtani F, Alkhouli M, Gallo J, et al. Acute vascular ischemic events in patients with central retinal artery occlusion in the United States: a nationwide study 2003-2014. Am J Ophthalmol. 2019;200:179–86.
Klein R, Klein BE, Jensen SC, Moss SE, Meuer SM. Retinal emboli and stroke: the Beaver Dam Eye Study. Arch Ophthalmol. 1999;117:1063–8.
Rim TH, Han J, Choi YS, Hwang SS, Lee CS, Lee SC, et al. Retinal artery occlusion and the risk of stroke development: twelve-year nationwide cohort study. Stroke. 2016;47:376–82.
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(Pt6):821–7.
Ho JD, Liou SW, Lin HC. Retinal vein occlusion and the risk of stroke development: a five-year follow-up study. Am J Ophthalmol. 2009;147:283–90.e282.
Rim TH, Kim DW, Han JS, Chung EJ. Retinal vein occlusion and the risk of stroke development: a 9-year nationwide population-based study. Ophthalmology. 2015;122:1187–94.
Chen YY, Yen YF, Lin JX, Feng SC, Wei LC, Lai YJ, et al. Risk of ischemic stroke, hemorrhagic stroke, and all-cause mortality in retinal vein occlusion: a nationwide population-based cohort study. J Ophthalmol. 2018;2018:8629429.
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.
Werther W, Chu L, Holekamp N, Do DV, Rubio RG. Myocardial infarction and cerebrovascular accident in patients with retinal vein occlusion. Arch Ophthalmol. 2011;129:326–31.
Ponto KA, Scharrer I, Binder H, Korb C, Rosner AK, Ehlers TO, et al. Hypertension and multiple cardiovascular risk factors increase the risk for retinal vein occlusions: results from the Gutenberg Retinal Vein Occlusion Study. J Hypertens. 2019;37:1372–83.
Barnett EM, Fantin A, Wilson BS, Kass MA, Gordon MO. The incidence of retinal vein occlusion in the ocular hypertension treatment study. Ophthalmology. 2010;117:484–8.
North BJ, Sinclair DA. The intersection between aging and cardiovascular disease. Circ Res. 2012;110:1097–108.
Park SJ, Choi N-K, Yang BR, Park KH, Woo SJ. Risk of stroke in retinal vein occlusion. Neurology. 2015;85:1578–84.
Woo SCY, Lip GYH, Lip PL. Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review. Eye. 2016;30:1031–8.
Yousufuddin M, Young N. Aging and ischemic stroke. Aging (Albany NY). 2019;11:2542–4.
CYB is funded by AHA Award 857722 and NIDDK K23 DK129836. MFB is supported by NIH Research Grant P30CA016359 from the National Cancer Institute.
The authors declare no competing interests.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bakhoum, C.Y., Madala, S., Long, C.K. et al. Retinal vein occlusion is associated with stroke independent of underlying cardiovascular disease. Eye 37, 764–767 (2023). https://doi.org/10.1038/s41433-022-02038-x