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Updated: Nov 7, 2025
A Murine Model of Ischemic Retinal Injury Induced by Transient Bilateral Common Carotid Artery Occlusion
Published on: November 12, 2020
The association of stroke with central and branch retinal arterial occlusion
Drew Scoles1, Brendan McGeehan2, Brian L VanderBeek3,4,5
1Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Insights
Stroke risk significantly increases immediately after a retinal artery occlusion (RAO). This finding highlights the critical need for prompt medical evaluation following RAO diagnosis to prevent further cerebrovascular events.
Area of Science:
- Ophthalmology
- Neurology
- Epidemiology
Background:
- Retinal artery occlusion (RAO) is a serious condition that can precede cerebrovascular events.
- Understanding the near-term risk of stroke post-RAO is crucial for timely intervention.
Purpose of the Study:
- To quantify the immediate risk of stroke following a retinal artery occlusion (RAO).
- To compare stroke risk after RAO with other conditions like hip fracture.
Main Methods:
- Utilized a US medical claims database for a self-controlled case series (SCCS) and propensity score (PS) matched cohort study.
- Assessed stroke incidence in the 30 and 7 days before and after RAO diagnosis (index date).
- Compared stroke hazard in RAO patients versus hip fracture patients using Cox regression.
Main Results:
- SCCS analysis (16,193 RAO patients) showed significantly increased stroke incidence in the month (IRR: 1.68-6.40) and week (IRR: 1.93-29.00) post-RAO.
- PS analysis (18,213 matched patients) revealed a higher stroke hazard after RAO compared to hip fracture (HR: 2.97).
- Central (CRAO) and Branch (BRAO) retinal artery occlusions showed elevated stroke hazards (HR: 3.24 and 2.76, respectively).
Conclusions:
- The risk of stroke is highest in the immediate days following central (CRAO) or branch (BRAO) retinal artery occlusion.
- These findings support current guidelines recommending immediate referral to a stroke center upon RAO diagnosis.
Objectives:
To determine the near-term risk of stroke following a retinal artery occlusion (RAO).
Methods:
The risk of stroke was assessed in two manners; with a self-controlled case series (SCCS) and a propensity score (PS) matched cohort study using a US medical claims database. The date of RAO diagnosis was assigned as the index date. In the SCCS, incidence of stroke was compared in 30- and 7-day periods pre- and post-index date. In PS analysis, matched cohorts were created from patients with RAO or hip fracture. Cox proportional hazard regression assessed the hazard for stroke. Patients were censored at 1 year, upon leaving the insurance plan or if they had a qualifying event for the comparison group.
Results:
The SCCS included 16,193 patients with RAO. The incidence rate ratio (IRR) of new stroke in the month after RAO was increased compared to all periods >2 months before and all months after the index date (IRRs: 1.68-6.40, p < 0.012). Risk was increased in the week immediately following the index date compared to most weeks starting 2 weeks prior to and all weeks immediately after the index date (IRRs: 1.93-29.00, p < 0.026). The PS study analysed 18,213 propensity-matched patients with RAO vs. hip fracture. The HR for having a stroke after RAO compared to a hip fracture was elevated in all analyses (All RAO HR: 2.97, 95% CI: 2.71-3.26, p < 0.001; CRAO HR: 3.24, 95% CI: 2.83-3.70, p < 0.001; BRAO HR: 2.76, 95% CI: 2.43-3.13, p < 0.001).
Conclusions:
The highest risk for stroke occurs in the days following a CRAO or BRAO, supporting guidelines suggesting immediate referral to a stroke centre upon diagnosis.
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