Systemic Vascular Risks After Retinal Artery and Vein Occlusions: A Large-Scale Real-World Analysis

PURPOSE: To compare systemic vascular disease risk among central and branch retinal artery occlusion (CRAO, BRAO) and central and branch retinal vein occlusion (CRVO, BRVO). METHODS: This retrospective cohort study used TriNetX to compare hazard ratios (HR) for ischemic stroke (IS), ischemic heart disease (IHD), myocardial infarction (MI), atrial fibrillation (AF), and mortality among 129,468,002 patients with CRAO, CRVO, BRAO, or BRVO diagnosed between January 1, 2015, and July 5, 2026, using propensity score-matched data. RESULTS: Retinal artery occlusions (RAO) were associated with significantly higher risks of all measured outcomes than retinal vein occlusions (RVO), including IS (HR, 1.954), IHD (HR, 1.368), MI (HR, 1.313), AF (HR, 1.530), and mortality (HR, 1.299) (all P<0.0001). BRAO carried higher risk than BRVO across all outcomes. CRAO carried higher risk than BRAO for MI and mortality only, and higher risk than CRVO across all outcomes, most strongly for IS (HR, 2.259). CRVO carried higher mortality risk than BRVO, with no significant difference in other outcomes. CONCLUSION: Retinal artery occlusions have a substantially greater systemic vascular risk than retinal vein occlusions. This supports urgent systemic evaluation following retinal arterial occlusion, particularly CRAO, to identify patients at highest risk for life-threatening thromboembolic events.