Association Between Retinal Vascular Occlusions and Stroke in Individuals With Atrial Fibrillation

atrial fibrillation retinal artery occlusions retinal vein occlusions stroke T he CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age 75 years, diabetes, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, and sex category) score is a tool used to guide anticoagulation decisions in patients with atrial fibrillation (AF). 1 Identifying additional risk factors may help improve stroke risk stratification.Retinal artery occlusion (RAO) and retinal vein occlusion (RVO) have been linked to stroke and established risk factors, including age, hypertension, and ischemic heart disease. 2,3Here, we investigated whether RAO or RVO are significantly associated with stroke among individuals with AF, after adjusting for individual risk factors that comprise the CHA 2 DS 2 -VASc score.Our goal was to determine whether these retinal vascular events offer novel prognostic information that could refine stroke-risk stratification in this high-risk population.This is a cross-sectional study approved by Yale's institutional review board with a waiver of informed consent due to the retrospective nature of the study.The study was conducted in accordance with Health Insurance Portability and Accountability Act regulations and ethical standards consistent with the Declaration of Helsinki.The data that support the findings of this study are available from the corresponding author on reasonable request.Individuals 30 years and older, who underwent an evaluation by an ophthalmologist or optometrist as well as by a general practitioner at Yale University or Yale New Haven Health System between January 2015 and December 2023 and had a diagnosis of AF, were included.Diagnostic records were obtained through the electronic medical record tool, Epic SlicerDicer, and using the International Classification of Diseases, Tenth Revision (ICD-10), diagnostic codes.The primary variables of interest were RAO and RVO, and the main outcome was stroke.Multivariable logistic regression models were used to evaluate the relationship between RAO or RVO and stroke in individuals with AF.The differences between groups were evaluated using 2 test for categorical variables and independent t test for continuous variables.Comparisons between models were made using the likelihood ratio test.Given that stroke was the outcome measure in this cross-sectional analysis, it was not included in the modified CHA 2 DS 2 -VASc score calculation.Statistical analyses were conducted using R version 4.4.2(R Foundation for Statistical Computing) and GraphPad Prism 10.4.1.A total of 10 134 individuals with AF met the inclusion criteria.We identified 152 and 217 individuals in the cohort with a diagnosis of RAO or RVO, respectively, and 23 individuals with a diagnosis of both.Those with retinal vascular occlusions tended to be older (79 years versus 75 years, P<0.001) compared with those without and there was no significant difference in the distribution of sex between the 2 groups.Individuals