Retinal artery occlusions: an ophthalmological perspective on atrial fibrillation

Retinal artery occlusions (RAO) are sentinel markers of systemic vascular disease. Beyond well-established risk factors (hypertension, diabetes, dyslipidemia), accumulating evidence links RAO with atrial fibrillation (AF). This manuscript narratively synthesizes observational cohorts, case-control studies, and registry analyses evaluating the bidirectional association between RAO and AF. We appraise the diagnostic yield of AF screening strategies after ocular events and outline clinical implications for thrombo-embolic risk reduction. Across studies, the prevalence of AF is consistently higher after RAO, although effect sizes vary with study design and ascertainment methods. Brief, single-time-point ECG screening frequently misses paroxysmal AF, whereas prolonged monitoring (e.g. 7-14-day patches and implantable loop recorders) increases detection in selected high-risk patients. Currently, no guidelines recommend routine AF screening after retinal artery occlusion; however, risk-stratified pathways grounded in age, vascular comorbidity, and ocular phenotype appear pragmatic. We propose a practical algorithm for AF detection after RAO and summarize ophthalmology-centered management considerations (timely cardiology referral, antithrombotic therapy, and secondary prevention). Key evidence gaps include standardized AF ascertainment, prospective screening trials, and health-economic evaluation. Addressing these could inform future recommendations and reduce preventable stroke and vision loss.