Daylight saving time transition and new-onset retinal vascular disease: a nationwide cohort study

Daylight saving time (DST) transitions lead to disruptions in circadian rhythm, and studies have identified an association between DST transitions and cardiovascular events. Changes in retinal microvasculature can reflect systemic cardiovascular health. This study investigated the relationship between DST transitions and retinal vascular disease. Patients aged 18-64 years old enrolled in the Merative MarketScan Commercial Database between 2012 and 2014 were identified. Incidence of new diagnosis of retinal artery occlusion (RAO), retinal vein occlusion (RVO), proliferative diabetic retinopathy (PDR), and neovascular age-related macular degeneration (nvAMD) were determined after autumn DST transition, spring DST transition, and a summer or winter control period. Survival analysis via Kaplan Meier curves and Cox proportional hazards models were used to determine the effect of variables of interest on new-onset retinal vascular disease during one-week and one-month periods following DST transition. We identified 12,640,343 patients who met inclusion criteria. With a summer control period, there was lower risk of RVO (adjusted hazard ratio [98.75% confidence interval]: 0.84 [0.72-0.99], P = 0.033), and PDR (0.83 [0.73-0.94], P = 0.001) in the month following autumn DST transition. There was higher risk of PDR (1.34 [1.19-1.50], P<0.0001) and nvAMD (1.24 [1.03-1.50], P = 0.015) in the month following spring DST transition. With a winter control period, there was lower risk of RAO (0.75 [0.60-0.94], P = 0.005), RVO (0.66 [0.53-0.82], P<0.0001), PDR (0.61 [0.51-0.72], P<0.0001), and nvAMD (0.64 [0.49-0.83], P < 0.0001) in the month following autumn DST transition. Further investigation into the effects of circadian disruption on ocular health is warranted.