Elsevier

Ophthalmology

Volume 122, Issue 6, June 2015, Pages 1187-1194
Ophthalmology

Original article
Retinal Vein Occlusion and the Risk of Stroke Development: A 9-Year Nationwide Population-Based Study

https://doi.org/10.1016/j.ophtha.2015.01.020Get rights and content

Purpose

To evaluate the risk of stroke development after retinal vein occlusion (RVO).

Design

Nationwide, population-based 9-year longitudinal study.

Participants

National registry data were collected from the Korean National Health Insurance Research Database, comprising 1 025 340 (∼2.2%) random subjects who were selected from 46 605 433 Korean residents in 2002.

Methods

Patients diagnosed with RVO or stroke in 2002 were excluded. The RVO group was composed of patients with an initial diagnosis of central or branch RVO between January 2003 and December 2005 (n = 344 in 2003, 375 in 2004, and 312 in 2005). The comparison group was composed of randomly selected patients (5 per patient with RVO; n = 1696 in 2003, 1854 in 2004, and 1524 in 2005) who were matched to the RVO group according to age, sex, residential area, household income, and year of RVO diagnosis. Each sampled patient was tracked until 2010. Cox proportional hazard regressions were used to calculate the overall survival rate for stroke development after adjusting for potential confounders, including hypertension, diabetes mellitus, and chronic kidney disease.

Main Outcome Measures

Retinal vein occlusion and ischemic or hemorrhagic stroke based on the International Classification of Disease codes.

Results

Stroke developed in 16.8% of the RVO group and in 10.7% of the comparison group. Retinal vein occlusion was associated with an increased risk of stroke development (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.24–1.76). Hypertension, diabetes mellitus, and chronic kidney disease also increased the risk of stroke development. In addition, RVO increased the risk of both ischemic stroke (HR, 1.51; 95% CI, 1.24–1.84) and hemorrhagic stroke (HR, 1.30; 95% CI, 0.83–2.05), although this result was not significant for hemorrhagic stroke. In terms of age, the effect size of the HR was largest among younger adults, aged <50 years (HR, 2.69), compared with middle-aged adults, aged 50 to 69 years (HR, 1.33), and older adults, aged ≥70 years (HR, 1.46).

Conclusions

Retinal vein occlusion was significantly associated with stroke development after adjusting for potential confounders. These findings are limited by uncontrolled confounding and need to be replicated by other observational studies.

Section snippets

Statement of Ethics

This study adhered to the tenets of the Declaration of Helsinki, and the NHIS-NSC 2002–2010 project was approved by the Institutional Review Board of the Korean National Health Insurance Service (KNHIS). This study design was reviewed and approved by the Institutional Review Board of the National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea. Written informed consent was waived.

Database

In Korea, all nationals are obligated to enroll in the KNHIS. A total of 97% and 3% of the Korean

Results

Table 1 displays the characteristics of the study population for the 2 cohorts: the RVO group and the comparison group. The subjects with RVO were more likely to experience stroke (P < 0.001), hypertension (P < 0.001), diabetes mellitus (P < 0.001), and chronic kidney disease (P < 0.001) compared with the comparison group. No significant difference in year of RVO diagnosis, age, sex, residential area, or household income was detected between the 2 groups; because these variables were used for

Discussion

In this study, we examined 6105 sociodemographically matched subjects who were extracted from a national database of 1 025 340 randomly selected subjects. We found that patients with RVO exhibited a higher prospective risk for stroke development during an 8-year follow-up period after adjusting for hypertension, diabetes, and chronic kidney disease. On the basis of subgroup analysis, the patients with RVO exhibited a higher risk of ischemic stroke and hemorrhagic stroke. However, the RVO group

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    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the NHIS Ilsan Hospital Grant (NHIMC 2014-20-005). This study used NHIS-NSC data (NHIS-2014-2-068), made by the NHIS. The authors alone are responsible for the content and writing of the article.

    Author Contributions

    Conception and design: Rim, Kim, Chung

    Analysis and interpretation: Rim, Kim, Han, Chung

    Data collection: Rim, Kim, Han, Chung

    Obtained funding: Not applicable

    Overall responsibility: Chung

    ∗

    Both authors (T.H.R. and D.W.K.) contributed equally to this study.

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