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Patients with retinal vein occlusions have increased mortality risk
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Patients with retinal vein occlusions have an increased risk of cardiovascular events and all-cause mortality, according to a study.
“Given the association of retinal microcirculatory dysfunction with systemic diseases, and the ability to noninvasively examine the retinal microvasculature, there has been significant research interest in the predictive value of RVO for incident cardiovascular events and mortality,” Chris Y. Wu, MD, and colleagues wrote.
The researchers conducted a systematic review and meta-analysis of 15 longitudinal cohort studies published in PubMed, Embase and the Cochrane Library. The targeted studies were those that evaluated association of the baseline retinal vein occlusion (RVO) that provided a multivariate-adjusted risk estimate with 95% confidence intervals with an average follow-up of at least 1 year.
The study used the Newcastle-Ottawa scale to assess the study quality. A score of 3 or less was considered poor quality, scores between 4 and 6 were considered moderate quality, and scores between 7 and 9 were considered high quality.
Results from the analysis showed that each study had a score of at least 6, indicating a moderate-to-high quality in the studies published. RVO was associated with increased risk of stroke, myocardial infarction, heart failure, peripheral arterial disease and all-cause mortality. The results of this analysis were consistent with prior meta-analysis that showed that patients with RVO had an increased 10-year risk of cardiovascular disease, but not cardiovascular mortality.
“Our results show that RVO is associated with an increased risk of all-cause mortality, but not cardiovascular mortality,” Wu and colleagues wrote. “Both analyses had substantial heterogeneity, and only two studies met inclusion criteria for the cardiovascular mortality analysis.”
The researchers concluded that more studies are required to determine the highest risk period for cardiovascular events and mortality after RVO and whether immediate evaluation, intervention or counseling will improve patient outcomes. – by Erin T. Welsh
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Carlo J. Pelino, OD
RVOs present to the eye care office on a regular basis. They are the second most common retinal vascular disease after diabetic retinopathy and are a common cause of visual morbidity in the elderly population. These occlusions occur from a thrombus or reduced blood flow in the central retinal vein that drains the retina or one of its branches.
Atherosclerotic diseases remain a major concern reported in most RVO patients and include diseases such as diabetes, high blood pressure and dyslipidemia, along with coagulation disorders. A large number of other factors (obesity, smoking) may also increase the risk of thrombotic events. Overall, a variety of systemic disorders may be present in association with different types of RVOs and also in different age groups. It is important for the eye care physician to understand that the pathophysiology of RVO is a multifactorial process.
Until further research is available on timely intervention following an RVO, eye care physicians can coordinate cardiovascular testing themselves to determine the etiology of the occlusion or they can refer the patient to their family doctors, internists or hematologists. The association of RVO with systemic cardiovascular diseases emphasizes the need to thoroughly investigate cardiovascular risk factors in these patients. Ultimately, eye care providers need to decide if it is warranted to perform an extensive and expensive workup for systemic diseases in the vast majority of patients with RVO.
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