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Updated: Aug 9, 2026
Retinal Vascular Reactivity as Assessed by Optical Coherence Tomography Angiography
Published on: March 26, 2020
Cardiovascular risk assessment in patients with retinal vein occlusion
S C Martin1, A Butcher, N Martin
1Department of Clinical Biochemistry and Immunology, Heartlands Hospital, Birmingham, UK. s.c.martin@doctors.org.uk
Insights
Patients with retinal vein occlusions (RVO) have a higher risk of cardiovascular disease (CVD). The Framingham algorithm accurately assesses this risk, guiding preventative CVD treatment decisions for RVO patients.
Area of Science:
- Ophthalmology
- Cardiology
- Public Health
Background:
- Retinal vein occlusions (RVO) are associated with an elevated risk of cardiovascular disease (CVD).
- Accurate risk stratification is crucial for implementing timely preventative CVD interventions in RVO patients.
Purpose of the Study:
- To determine the future CVD risk in patients diagnosed with RVO using the Framingham risk algorithm.
- To evaluate the utility of calculated cardiovascular disease risk (cCVDR) and calculated coronary heart disease risks (cCHDR) in guiding preventative CVD treatment for RVO patients.
Main Methods:
- A cohort of 107 unselected RVO patients was analyzed.
- After exclusions, 89 patients had their 10-year cCVDR and cCHDR calculated using the Framingham algorithm.
- Calculated risks were compared against standardized risks and published coronary heart disease (CHD) incidence data for England.
Main Results:
- Mean 10-year cCVDR was significantly higher in RVO patients (20.6%) compared to Framingham standardized risk (15.7%).
- Males with RVO showed a twofold increase in expected cCHDR >15% (62% vs. 28%) and a sixfold increase for cCHDR >30% (17% vs. 3%).
- Female RVO patients exhibited a fourfold increase in cCHDR >15% (40% vs. 9%) and a significant rise for cCHDR >30% (10% vs. 0%). Branch RVO (BRVO) patients had higher cCHDRs, linked to systolic hypertension and age.
Conclusions:
- RVO serves as a presenting sign for individuals at increased risk of CVD, aligning with data showing higher CVD mortality in RVO patients.
- The Framingham algorithm effectively calculates cCHDR/cCVDR, aiding clinicians in treatment decisions for hypertension, lipid management, and aspirin therapy per guidelines.
Aim:
Patients with retinal vein occlusions (RVO) are at increased risk of cardiovascular disease (CVD). The risk of future CVD was determined using the Framingham algorithm and this risk estimate was used to guide decisions about preventative treatment for CVD in RVO patients.
Methods:
107 unselected RVO patients were studied. After excluding 18 patients because of age, missing data, or pre-existing cardiovascular disease, the calculated coronary heart disease risks (cCHDR) and calculated cardiovascular disease risks (cCVDR) were calculated on the 89 remaining and compared with both the standardised risk and the published incidence of CHD in England by t test or chi(2) test.
Results:
The mean 10 year cCVDR was significantly higher than the Framingham standardised risk for all RVOs (20.6% (1.2%) v 15.7% (1.1%), p = 0.009) and female RVOs (17.8% (1.2%) v 12.7% (1.0%), p = 0.022) in particular. The 10 year cCHDR, compared to the actual incidence of CHD in England between the ages of 30 and 74 years, was > 15% in twice as many males than expected (62% v 28%, p <0.0001). This rose to almost six times when cCHDRs greater than 30% were compared (17% v 3%, p = 0.002). There was a fourfold increase in the proportion of female RVO patients with a cCHDR above 15% (40% v 9%, p <0.0001) and at a cCHDR of 30% and above (10% v 0%, p = 0.004). There were also significant differences in the cCHDR between central and branch RVO (both sexes). The branch form of RVO (BRVO) having higher cCHDRs because of systolic hypertension (164.1 (21.6) mm Hg v 149.5 (23.5) mm Hg, p = 0.003) and age (61.7 (8.3) years v 56.7 (10.6) years, p = 0.017).
Conclusions:
RVO is the presenting complaint in a group of patients at increased risk of CVD and is in agreement with the long term follow up data demonstrating an increased mortality from CVD in patients with RVO. The Framingham algorithm can accurately determine the cCHDR (or cCVDR) to assist the clinician in deciding who to treat in accordance with the Joint British Societies' guidelines, with particular regard to hypertension, lipid lowering, and the use of aspirin therapy.
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