Risk of cardiovascular events and death following retinal arterial occlusion and transient monocular visual loss

Acute retinal ischaemic events, ranging from central retinal artery occlusions (CRAO) and branch retinal artery occlusions (BRAO) to transient ischaemic monocular vision loss (TMVL), cause sudden and often severe vision loss, yet their broader implications for systemic vascular health are not well defined. To investigate this, we conducted a large, propensity-matched cohort study including a total of 566 patients at an academic ophthalmic hospital in London, United Kingdom, linking ophthalmic diagnoses to national records of cardiovascular events and mortality. Our findings reveal that patients experiencing a CRAO have a nearly threefold increased risk of a subsequent ischaemic stroke or myocardial infarction, when compared to matched controls. This elevated risk, however, was not apparent in individuals who suffered a BRAO or TMVL, suggesting a distinct risk profile for CRAO. Systemic comorbidities like hypertension and diabetes were prevalent in all groups. Atrial fibrillation was newly diagnosed in 6% of patients with CRAO within one year. Patients with BRAO were more likely to undergo carotid endarterectomy than those with CRAO. The substantial risk of serious cardiovascular morbidity following retinal arterial ischaemia highlights the need to ensure such patients benefit from early treatment and prolonged cardiac monitoring and rigorous implementation of secondary prevention in RAO and suspected embolic TMVL.