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Risk and Predictors of Fellow-Eye Involvement after Unilateral Retinal Artery Occlusion
Jawad Muayad1, Sam Karimaghaei1, Muhammad Z Chauhan1
1Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Ophthalmology. Retina
|July 9, 2026
Summary
Fellow-eye retinal artery occlusion (RAO) affects about 1 in 25 central RAO and 1 in 31 branch RAO patients within 5 years. Risk factors and event patterns suggest different causes, highlighting the need for close monitoring after initial RAO.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Retinal artery occlusion (RAO) is a serious vascular event affecting vision.
- Understanding the risk of fellow-eye involvement after unilateral RAO is crucial for patient management.
- Predictors and temporal patterns of fellow-eye RAO require further elucidation.
Purpose of the Study:
- To determine the 5-year event probability of fellow-eye RAO after unilateral central RAO (CRAO) or branch RAO (BRAO).
- To analyze the temporal pattern of fellow-eye RAO development.
- To identify baseline predictors associated with fellow-eye RAO.
Main Methods:
- Retrospective cohort study of 10,085 CRAO and 9,574 BRAO patients from the TriNetX US Collaborative Network (2015-2025).
- Kaplan-Meier analysis estimated 5-year event probability.
- Baseline characteristics were compared between patients with and without fellow-eye RAO using statistical tests with Bonferroni correction.
Main Results:
- Fellow-eye RAO occurred in 4.06% of CRAO patients and 3.22% of BRAO patients within 5 years.
- Index RAO type predicted fellow-eye RAO subtype (CRAO to CRAO, BRAO to BRAO).
- Significant predictors for CRAO included cerebral infarction, carotid stenosis, hypertension, diabetes, diabetic retinopathy, and sleep apnea; for BRAO, predictors included retinal vasculitis, ocular hypertension, and diabetes-related factors.
Conclusions:
- Fellow-eye RAO incidence is approximately 1 in 25 for CRAO and 1 in 31 for BRAO within 5 years.
- Concordance of RAO subtype and distinct risk profiles suggest different pathophysiologies.
- Findings support patient counseling and emphasize close follow-up in the initial months post-RAO.
