Increased Stroke Risk After Retinal Occlusion – EMJ

RETINAL artery occlusion (RAO) may signal an increased risk of future cardiovascular events, according to data from a large cohort study.  

Researchers linked ophthalmic records to national hospital admissions and mortality data, to examine subsequent cardiovascular outcomes. Patients with central RAO experienced substantially increased risk of both ischaemic stroke and myocardial infarction, compared to their matched controls. 

Retinal Artery Occlusion and Cardiovascular Outcomes 

The study included 566 patients diagnosed between 2011 and 2018 with acute retinal arterial ischaemia (either central RAO, branch RAO, or transient vision loss) at Moorfields Eye Hospital, London, United Kingdom.  

Among 190 patients with central RAO, five developed myocardial infarction and seven experienced ischaemic stroke following diagnosis. Compared with propensity matched controls, central RAO was associated with an increased risk of myocardial infarction (p=0.047) and ischaemic stroke (p=0.014). Mortality risk was also observed to be elevated, at the threshold of statistical significance (p=0.05). 

Atrial Fibrillation Detection Highlights Ongoing Risk 

The data also highlighted the substantial burden of cardiovascular comorbidity. High blood pressure, diabetes, and elevated cholesterol levels were common across all groups. In patients with central RAO, 6% received a new diagnosis of atrial fibrillation within one year of the event. 

Investigators proposed that atrial fibrillation may represent an important contributor to retinal ischaemic events. The findings support consideration of prolonged cardiac monitoring following acute retinal ischaemia, particularly in patients with central RAO. 

Differences Between Retinal Ischaemic Presentations 

In contrast to central RAO, neither branch ROA or transient vision loss showed significant increases in myocardial infarction, ischaemic stroke, or mortality compared with matched controls. 

However, approximately 5% of patients with branch RAO or transient vision loss underwent carotid endarterectomy following their event. Patients with branch RAO were also significantly more likely to receive carotid endarterectomy than those with central RAO (p=0.04). 

The researchers concluded that the cardiovascular burden associated with RAO extends beyond acute vision loss. Their findings support the need for early treatment, secondary prevention, and prolonged cardiac surveillance, to help reduce the risk of future cardiovascular morbidity in patients, following retinal arterial ischaemic events. 

Reference 

Huemer J et al. Risk of cardiovascular events and death following retinal arterial occlusion and transient monocular visual loss. Sci Rep. 2026; DOI: 10.1038/s41598-026-58854-8 

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