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Systemic diseases associated with various types of retinal vein occlusion
S S Hayreh1, B Zimmerman, M J McCarthy
1Departments of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa, USA. sohan-hayreh@uiowa.edu
Insights
Systemic diseases like hypertension and diabetes are linked to various retinal vein occlusions (RVOs). Prevalence differs by RVO type and age, suggesting individualized screening rather than generalized workups for RVO patients.
Area of Science:
- Ophthalmology
- Vascular Medicine
- Internal Medicine
Background:
- Retinal vein occlusion (RVO) is a significant cause of vision loss.
- Understanding associated systemic diseases is crucial for patient management.
Purpose of the Study:
- To investigate the prevalence of systemic diseases associated with different types of retinal vein occlusion (RVO).
- To compare systemic disease prevalence across RVO subtypes and age groups.
Main Methods:
- Prospective study of 1090 RVO patients categorized by RVO type (central, hemi-central, branch; ischemic/non-ischemic).
- Detailed ophthalmic and systemic evaluations were performed.
- Systemic disease prevalence was compared among RVO types and age groups, and against US control populations using logistic regression.
Main Results:
- Branch retinal vein occlusion (BRVO) showed higher rates of hypertension, peripheral vascular disease, venous disease, and gastrointestinal issues compared to central RVO (CRVO) and hemi-central RVO (HCRVO).
- Ischemic CRVO had higher hypertension and diabetes mellitus prevalence than non-ischemic CRVO.
- BRVO patients had higher rates of hypertension, cerebrovascular disease, COPD, peptic ulcers, and thyroid disorders compared to controls.
Conclusions:
- Systemic disease prevalence varies significantly across RVO types and age groups, making generalized assumptions misleading.
- Associated systemic diseases may not have a direct causal link but can be part of a multifactorial risk profile.
- Extensive systemic workups are generally unwarranted beyond routine medical evaluation for most RVO patients.
Purpose:
To investigate systemic diseases associated with various types of retinal vein occlusion.
Methods:
We investigated prospectively in 1090 consecutive patients with retinal vein occlusion, almost all Caucasian (consistent with the racial pattern here), the prevalence of associated systemic disorders before or at the onset of various types of retinal vein occlusion. The patients were categorized into six types of retinal vein occlusion based on defined criteria: nonischemic and ischemic central retinal vein occlusion, nonischemic and ischemic hemi-central retinal vein occlusion, and major and macular branch retinal vein occlusion. The patients had a detailed ophthalmic and systemic evaluation according to our protocol. For data analysis, patients were divided into three age groups: young (younger than 45 years), middle-aged (45 to 64 years), and elderly (65 years or older). The observed prevalence rates of major systemic diseases were compared among central retinal vein occlusion, hemi-central retinal vein occlusion, and branch retinal vein occlusion using a polytomous logistic regression analysis adjusting for gender and age. Logistic regression adjusting for age and gender was also used to compare the observed prevalence of systemic disease between nonischemic and ischemic in central retinal vein occlusion and hemi-central retinal vein occlusion and between major and macular branch retinal vein occlusion. These observed prevalence rates were also compared with those expected in a gender-matched and age-matched control population from estimates from the US National Center for Health Statistics.
Results:
There was a significantly higher prevalence of arterial hypertension in branch retinal vein occlusion compared with central retinal vein occlusion (P < .0001) and hemi-central retinal vein occlusion (P = .028). Branch retinal vein occlusion also had a significantly higher prevalence of peripheral vascular disease (P = .0002), venous disease (P = .011), peptic ulcer (P = .031), and other gastrointestinal disease (P < .0001) compared with central retinal vein occlusion. The proportion of patients with branch retinal vein occlusion with cerebrovascular disease was also significantly (P = .049) greater than that of the combined group of patients with central retinal vein occlusion and patients with hemi-central retinal vein occlusion. There was no significant difference in prevalence of any systemic disease between central retinal vein occlusion and hemi-central retinal vein occlusion. A significantly greater prevalence of arterial hypertension (P = .025) and diabetes mellitus (P = .011) was present in the ischemic central retinal vein occlusion compared with the nonischemic central retinal vein occlusion. Similarly, arterial hypertension (P = .0002) and ischemic heart disease (P = .048) were more prevalent in major branch retinal vein occlusion than in macular branch retinal vein occlusion. Relative to the US white control population, the combined group of patients with central retinal vein occlusion and patients with hemi-central retinal vein occlusion had a higher prevalence of arterial hypertension (P < .0001), peptic ulcer (P < .0001), diabetes mellitus (in ischemic type only, P < .0001), and thyroid disorder (P < .0001). The patients with branch retinal vein occlusion showed a greater prevalence of arterial hypertension (P < or = .005), cerebrovascular disease (P = .007), chronic obstructive pulmonary disease (P = .012), peptic ulcer (P < .0001), diabetes (in young only, P = .0005), and thyroid disorder (P = .003) compared with the US white control population.
Conclusions:
The findings of our study revealed that a variety of systemic disorders may be present in association with different types of retinal vein occlusion and in different age groups, and that their relative prevalence differs significantly, so that the common practice of generalizing about these disorders for the entire group of patients with retinal vein occlusion can be misleading. The presence of a particular associated systemic disease does not necessarily imply a cause-and-effect relationship with that type of retinal vein occlusion; the particular disease may or may not be one of the risk factors in a multifactorial scenario predisposing an eye to develop a particular type of retinal vein occlusion. Based on our study, we think that apart from a routine medical evaluation, an extensive and expensive workup for systemic diseases is unwarranted in the vast majority of patients with retinal vein occlusion.