Laterality of Retinal Vascular Occlusion Depends on Subtype

Retinal vascular occlusion (RVO) is a leading cause of vision loss in middle-aged and elderly populations worldwide. Using a large U.S. registry, Tobias Elze, PhD, assistant scientist at Schepens Eye Research Institute of Mass Eye and Ear and assistant professor of Ophthalmology at Harvard Medical School, and colleagues investigated age, gender and ocular laterality at the onset of RVO.

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Their report, published in Ophthalmology Retina, highlights differences among the seven subtypes of RVO that may improve understanding of the causes and treatment of these retinopathies.

Study Methods

The researchers used data from the IRIS (Intelligent Research in Sight) Registry—the nation's first electronic health record-based comprehensive eye disease and condition registry, which is maintained by the American Academy of Ophthalmology.

Mass Eye and Ear was one of four academic groups selected nationwide to receive unique access to the IRIS® Registry to help answer large-scale questions about ophthalmic disease. The registry now contains data on more than 71 million patients.

In this recent study, the team analyzed IRIS data on 1,251,476 patients who had records included between January 1, 2013, and December 31, 2017, and were diagnosed with RVO on the first visit.

Prevalence of RVO Subtypes

Retinal artery occlusion—23.8% of cases

• Branch retinal arterial occlusion (BRAO)—8.3%
• Central retinal artery occlusion (CRAO)—6.1%
• Transient retinal arterial occlusion (TRAO)—4.9%
• Partial retinal arterial occlusion (PRAO)—4.5%

Retinal vein occlusion—76.2%

• Branch retinal vein occlusion (BRVO)—45.9%
• Central retinal vein occlusion (CRVO)—28.6%
• Venous engorgement (VE)—1.7%

Age

The frequency of onset rose with increasing age between 0 and 85 years. Only 0.5% of patients were younger than 25 years, whereas 70% were 65–85 years old.

For all subtypes, there was a positive correlation between age and onset frequency (correlation coefficients 0.82–0.93).

Gender

• BRAO—2.6% more frequent among men than women
• CRAO—5.3% more frequent among men
• TRAO—9.8% more frequent among women
• PRAO—7.0% more frequent among men
• BRVO—8.9% more frequent among women
• CRVO—0.9% more frequent among men
• VE—12.0% more frequent among women

The gender differences were significant for all subtypes (P<0.0001).

Laterality

Unilateral onset was significantly more frequent for RVO than for other diagnoses in the IRIS registry (91% vs. 32%; OR, 19.92). The same was true for each subtype (P<0.0001).

For BRVO and all four subtypes of RAO, onset was more frequent in the right eye than the left. For CRVO and VE, left-eye onset was more frequent. Laterality differences were significant for all subtypes (P<0.0001).

Avenues for Future Research

• 70% of patients with retinal vascular occlusion were 65–85 years old
• 9% greater frequency of branch retinal vein occlusion among women than men
• 12% greater frequency of venous engorgement among women than men
• 20x greater odds that retinal vascular occlusion would have unilateral onset compared with other ophthalmic diagnoses
• 7% greater frequency of retinal artery occlusion in the right eye compared to the left

Analyses that also consider systemic comorbidities, ophthalmic comorbidities and medication use should clarify the pathogenesis of RVO. For example, the trend for disease onset to increase with age may be linked to worsening cardiovascular disease with age.

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