Retinal Vein Occlusion as a Predictor of Stroke

Retinal vein occlusion (RVO) is well known as one of the leading causes of vision loss among middle-aged and older adults. However, emerging evidence suggests that its implications extend beyond the eye and into systemic vascular risks.

A new systematic review and meta-analysis published in BMC Ophthalmology explores this connection, focusing on whether RVO signals a heightened risk for cerebrovascular accidents (CVA), including both ischemic and hemorrhagic strokes.

Here’s a brief look at this review and its findings.

How Was the Review Designed?
The researchers reviewed data from 14 studies—encompassing 97,812 patients—to examine whether individuals diagnosed with RVO are at elevated risk for stroke and related cardiovascular events. Studies included retrospective and prospective cohort studies, as well as case-control studies. Patients were at least 18 years or older with either branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).

What Did the Review Find?
Looking at the results, the meta-analysis uncovered a strong and consistent association between RVO and stroke across 10 studies, showing that 37.5 percent of patients with RVO experienced a CVA (p < 0.001) with no significant heterogeneity observed across studies (I² = 0 percent, p = 0.97).

Across stroke subtypes, the review found the following:

• • Ischemic CVA: 37.8 percent event rate (p < 0.001)
  • Hemorrhagic CVA: 32.7 percent event rate (p < 0.001)
  • Rates were similar for BRVO and CRVO, suggesting stroke risk does not vary by RVO subtype.

Among patients with RVO who experienced a stroke, mortality reached 69 percent (p < 0.001), highlighting the severity associated with these dual vascular conditions. Ischemic cardiovascular events, including myocardial infarction, occurred in 15.7 percent of patients, and deep vein thrombosis (DVT) was rare but present, with a 0.05 percent incidence rate.

The findings were further supported by subgroup and sensitivity analyses, which consistently reinforced the robustness of the results.

What Are the Clinical Implications of the Findings?
The study positions RVO as more than an ocular condition and suggests it may serve as a systemic vascular warning. Clinicians should consider RVO a red flag that warrants comprehensive evaluation of cerebrovascular and cardiovascular health. For clinical practice, the study emphasizes several important strategies for managing patients with RVO:

• Early Screening and Risk Assessment: Patients with RVO should undergo proactive cardiovascular evaluations, including blood pressure management, lipid control, and glucose regulation.
• Preventive Strategies: Incorporating anticoagulation or antiplatelet therapy when indicated could reduce the likelihood of stroke and other thromboembolic events.
• Multidisciplinary Approach: Coordination among ophthalmologists, neurologists, and cardiologists is essential to proactive stroke prevention.

Future research should explore genetic risk factors, inflammatory pathways, and AI-driven predictive models to refine risk stratification and guide personalized interventions. While this study relies primarily on observational data, its scale and methodological rigor make a compelling case for integrating stroke prevention into RVO care pathways.

Reference
Chen KY, Chan HC, Chan CM. Is there an association between retinal vein occlusion and cerebrovascular accident? A systematic review and meta-analysis. BMC Ophthalmol. 2025;25(1):112. Published 2025 Mar 6. doi:10.1186/s12886-025-03944-w