Comorbidity in Patients with Branch Retinal Vein Occlusion: Case-control Study

Mette Bertelsen, medical doctor, clinical research fellow, Allan Linneberg, senior researcher and head of department, Thomas Rosenberg, consultant ophthalmologist, Nynne Christoffersen, consultant ophthalmologist, Henrik Vorum, professor of ophthalmology, Else Gade, ophthalmologist, Michael Larsen, professor of ophthalmology

Abstract

Objectives To evaluate comorbidity before and after the diagnosis of branch retinal vein occlusion to determine whether it is a consequence of arterial thickening and therefore could serve as a diagnostic marker for other comorbidities and to evaluate the risk factors for the development of such occlusion.

Design Case-control study with prospective follow-up data from Danish national registries.

Setting Four secondary referral centres covering about 80% of the Danish population (4.4 million).

Participants 1168 patients with photographically verified branch retinal vein occlusion and 116?800 controls alive and aged ?40 when the occlusion was diagnosed in the corresponding case.

Main outcome measures The risk of comorbidity 10 years and 1 year before the diagnosis of branch retinal vein occlusion and the incident comorbidity in a mean period of seven years after the diagnosis, with odds ratios and incidence rate ratios adjusted for age, sex, and year of diagnosis.

Results Risk factors present 10 years and 1 year before the diagnosis of branch retinal vein occlusion included peripheral artery disease (odds ratio 1.83, 95% confidence interval 1.14 to 2.95), diabetes (1.74, 1.40 to 2.17) and arterial hypertension (2.16, 1.86 to 2.51). After the diagnosis, patients had an increased risk of developing arterial hypertension (incidence rate ratio 1.37, 95% confidence interval 1.15 to 1.57), diabetes (1.51, 1.17 to 2.04), congestive heart failure (1.41, 1.12 to 1.68), and cerebrovascular disease (1.49, 1.27 to 1.76).

Conclusion Diabetes, hypertension, and peripheral artery disease are associated with an increased risk of developing branch retinal vein occlusion up to a decade later. Branch retinal vein occlusion was associated with an increased risk of subsequently developing hypertension, diabetes, congestive heart failure, and cerebrovascular disease, emphasising the importance of preventive initiatives. These results fit the assumption that branch retinal vein occlusion is a consequence of arterial thickening and that the arteriovenous crossing signs that precede it are hallmarks of arterial disease.