Postacute sequelae of SARS-CoV-2 infection on ophthalmic diseases: a binational cohort study

Although health problems may persist beyond 4 weeks after SARS-CoV-2 infection, evidence on long-term ophthalmic sequelae is limited. We conducted a binational, population-based cohort study to evaluate the association between postacute sequelae of SARS-CoV-2 infection and the risk of multiple ophthalmic diseases.

Data were collected from two large cohorts: South Korea (discovery cohort; n=15,992,761) and Japan (validation cohort; n=12,218,680), including individuals aged ≥20 years who were infected with SARS-CoV-2. Cox proportional hazards models with propensity score-based overlap weighting were used to estimate HRs, with analyses stratified by COVID-19 severity and SARS-CoV-2 variant period.

In the overlap-weighted discovery cohort, 4 041 250 individuals (mean age 52.52 years (SD 11.52); 59.1% male) were included. SARS-CoV-2 infection was associated with a long-term increased risk of any ophthalmic disease (HR, 1.23 (95% CI, 1.22-1.25)). Elevated risks were observed for glaucoma (1.21 (1.19-1.23)), cornea and conjunctiva diseases (1.22 (1.21-1.23)), blepharitis (1.19 (1.17-1.22)), retinopathy (1.17 (1.15-1.18)), uveitis (1.11 (1.01-1.22)) and neuro-ophthalmic diseases (1.11 (1.06-1.15)). The risk of ophthalmic diseases gradually attenuated over time after SARS-CoV-2 infection. The risk was more pronounced among individuals with severe COVID-19. The associations between SARS-CoV-2 infection and the risk of ophthalmic diseases were generally consistent across the pre-Delta, Delta and Omicron eras. Similar patterns were consistently observed in the validation cohort.

Our findings suggest an increased risk of postacute ophthalmic sequelae following SARS-CoV-2 infection, underscoring the need for sustained clinical vigilance across a broad range of ophthalmic conditions.