Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Retinal vein occlusion is associated with stroke independent of underlying cardiovascular disease



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

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type



Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Frequencies of retinal vein occlusions and stroke.
Fig. 2: Odds ratio for stroke.

Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.


  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

  4. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. Scott IU, Campochiaro PA, Newman NJ, Biousse V. Retinal vascular occlusions. Lancet. 2020;396:1927–40.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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.

    Article  CAS  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  CAS  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. North BJ, Sinclair DA. The intersection between aging and cardiovascular disease. Circ Res. 2012;110:1097–108.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Park SJ, Choi N-K, Yang BR, Park KH, Woo SJ. Risk of stroke in retinal vein occlusion. Neurology. 2015;85:1578–84.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Yousufuddin M, Young N. Aging and ischemic stroke. Aging (Albany NY). 2019;11:2542–4.

    Article  PubMed  Google Scholar 

Download references


CYB is funded by AHA Award 857722 and NIDDK K23 DK129836. MFB is supported by NIH Research Grant P30CA016359 from the National Cancer Institute.

Author information

Authors and Affiliations



CYB and MFB designed the study. CYB, SM, SM, CKL, FA and MFB acquired and/or analyzed the data. CYB and MFB performed the statistical analysis. All authors participated in the writing and revision of the manuscript.

Corresponding author

Correspondence to Mathieu F. Bakhoum.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links