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. 2013 Feb;120(2):362-70.
doi: 10.1016/j.ophtha.2012.07.080. Epub 2012 Nov 20.

A longitudinal analysis of risk factors associated with central retinal vein occlusion

Maxwell S Stem  1 , Nidhi Talwar, Grant M Comer, Joshua D Stein
Affiliations

A longitudinal analysis of risk factors associated with central retinal vein occlusion

Maxwell S Stem et al. Ophthalmology. 2013 Feb.

Abstract

Purpose: To identify risk factors associated with central retinal vein occlusion (CRVO) among a diverse group of patients throughout the United States.

Design: Longitudinal cohort study.

Participants: All beneficiaries aged ≥ 55 years who were continuously enrolled in a managed care network for at least 2 years and who had ≥ 2 visits to an eye care provider from 2001 to 2009.

Methods: Insurance billing codes were used to identify individuals with a newly diagnosed CRVO. Multivariable Cox regression was performed to determine the factors associated with CRVO development.

Main outcome measures: Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of being diagnosed with CRVO.

Results: Of the 494 165 enrollees who met the study inclusion criteria, 1302 (0.26%) were diagnosed with CRVO over 5.4 (± 1.8) years. After adjustment for known confounders, blacks had a 58% increased risk of CRVO compared with whites (HR, 1.58; 95% CI, 1.25-1.99), and women had a 25% decreased risk of CRVO compared with men (HR, 0.75; 95% CI, 0.66-0.85). A diagnosis of stroke increased the hazard of CRVO by 44% (HR, 1.44; 95% CI, 1.23-1.68), and hypercoagulable state was associated with a 145% increased CRVO risk (HR, 2.45; 95% CI, 1.40-4.28). Individuals with end-organ damage from hypertension (HTN) or diabetes mellitus (DM) had a 92% (HR, 1.92; 95% CI, 1.52-2.42) and 53% (HR, 1.53; 95% CI, 1.28-1.84) increased risk of CRVO, respectively, relative to those without these conditions.

Conclusions: This study confirms that HTN and vascular diseases are important risk factors for CRVO. We also identify black race as being associated with CRVO, which was not well appreciated previously. Furthermore, we show that compared with patients without DM, individuals with end-organ damage from DM have a heightened risk of CRVO, whereas those with uncomplicated DM are not at increased risk of CRVO. This finding may provide a potential explanation for the conflicting reports in the literature on the association between CRVO and DM. Information from analyses such as this can be used to create a risk calculator to identify possible individuals at greatest risk for CRVO.

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Conflict of interest statement

No conflicting relationship exists for any author regarding any material discussed in this manuscript.

Figures

Figure 1
Figure 1
Selection of beneficiares of analysis
Figure 2
Figure 2
Multivariable Cox Regression
Figure 3
Figure 3
Effect of Severity of Diabetes and Hypertension on Risk of Being Diagnosed with Central Retinal Vein Occlusion
See this image and copyright information in PMC

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