Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis

Abstract

IMPORTANCE COVID-19 is associated with systemic vascular damage; however, the risk posed to the retinal vasculature remains incompletely understood. OBJECTIVE To assess if there is a change in the incidence of retinal vascular occlusions after COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS This cohort study at an integrated health care organization (Kaiser Permanente Southern California) included patients without a history of retinal vascular occlusion who were diagnosed with COVID-19 infection between January 20, 2020, and May 31, 2021. Patients were excluded if they had a history of retinal artery occlusions (RAOs) or retinal vein occlusions (RVOs) more than 6 months before their COVID-19 diagnosis or if they were enrolled in Kaiser Permanente Southern California for less than 6 months before COVID-19 diagnosis. EXPOSURES COVID-19 infection. MAIN OUTCOMES AND MEASURESThe change in the average biweekly incidence of new RAOs and RVOs after COVID-19 diagnosis. Adjusted incidence rate ratios (IRRs) were calculated to compare the incidence of retinal vascular occlusions before and after COVID-19 diagnosis after accounting for baseline demographic characteristics, medical history, and hospitalization.RESULTS A total of 432 515 patients diagnosed with COVID-19 infection were included in this study. The mean (SD) age was 40.9 (19.2) years, and 231 767 patients (53.6%) were women. Sixteen patients had an RAO (crude incidence rate, 3.00 per 1 000 000 patients), and 65 had an RVO (crude incidence rate, 12.20 per 1 000 000 patients) in the 6 months after COVID-19 diagnosis. The incidence of new RVOs was higher in the 6 months after COVID-19 infection compared with the 6 months before infection after adjusting for age; sex; self-reported race and ethnicity; body mass index; history of diabetes, hypertension, or hyperlipidemia; and hospitalization (adjusted IRR, 1.54; 95% CI, 1.05-2.26; P = .03). There was a smaller increase in the incidence of RAOs after COVID-19 diagnosis (IRR, 1.35; 95% CI, 0.64-2.85; P = .44). The peak incidence of RAOs and RVOs occurred 10 to 12 weeks and 6 to 8 weeks after COVID-19 diagnosis, respectively. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that there was an increase in the incidence of RVOs after COVID-19 infection; however, these events remain rare, and in the absence of randomized controls, a cause-and-effect relationship cannot be established. Further large, epidemiologic studies are warranted to better define the association between retinal thromboembolic events and COVID-19 infection.

Long COVID endotheliopathy: hypothesized mechanisms and potential therapeutic approaches

“…Hypoperfusion on arterial spin label was noted across the gray matter cortex, most prominent after severe COVID-19, suggesting microthrombosis ( 45 ). The latter is consistent with a recent report of retinal vein occlusions in PASC ( 85 ).…”

Retinal vascular occlusions in COVID-19 infection and vaccination: a literature review

“…As described above, most reports regarding retinal vascular occlusions are cases; therefore, their association with COVID-19 remains unclear. Two cohort studies concerning the incidence of retinal vascular occlusions in the COVID-19 period reported different trends [ 71 , 72 ]. One cohort study recently investigated the prevalence of retinal vascular occlusions before and during the COVID-19 pandemic period [ 71 ].…”

Risk Factors and Treatment Strategy for Retinal Vascular Occlusive Diseases

“…The incidence of retinal artery and vein occlusions slightly elevates within 12 weeks after COVID-19. In particular, an episode of COVID-19 within 6 months is a significant high-risk factor for retinal vein occlusion [ 73 , 74 ]. Moreover, COVID-19 exhibits retinal hemorrhage, cotton-wool spots, and dilated retinal arteries and veins [ 75 ].…”