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. 2024 Jan 22:15:1342491.
doi: 10.3389/fneur.2024.1342491. eCollection 2024.

Incidence of central retinal artery occlusion peaks in winter season

Caroline J Gassel  1 , Wolfgang Andris  1 , Sven Poli  2   3 , Karl Ulrich Bartz-Schmidt  1 , Spyridon Dimopoulos  1 , Daniel A Wenzel  1
Affiliations

Incidence of central retinal artery occlusion peaks in winter season

Caroline J Gassel et al. Front Neurol. .

Abstract

Introduction: Stroke incidence exhibits seasonal trends, with the highest occurrences observed during winter. This study investigates the incidence of central retinal artery occlusion (CRAO), a stroke equivalent of the retina, and explores its monthly and seasonal variations, as well as potential associations with weather and ambient air pollutants.

Methods: A retrospective search of medical records spanning 15 years (January 2008-December 2022) was conducted at the University Eye Hospital Tübingen, Germany, focusing on diagnosed cases of CRAO. Incidences were evaluated on a monthly and seasonal basis (winter, spring, summer, fall). Weather data (temperature, precipitation, atmospheric pressure) and concentrations of ambient air pollutants [fine particulate matter (PM2.5), coarse particulate matter (PM10), nitrogen dioxide (NO2), and ozone (O3)], were analyzed for a potential association with CRAO incidence.

Results: Out of 432 patients diagnosed with CRAO between 2008 and 2022, significantly varying incidences were observed monthly (p = 0.025) and seasonally (p = 0.008). The highest rates were recorded in February and winter, with the lowest rates in June and summer. Concentrations of NO2, PM2.5 and lower ambient air temperature (average, minimum, maximum) showed significant correlations with CRAO incidence.

Discussion: This comprehensive 15-year analysis reveals a pronounced winter peak in CRAO incidence, with the lowest occurrences in summer. Potential associations between CRAO incidence and ambient air pollutants and temperature underscore the importance of considering seasonal trends and call for further investigations to elucidate contributing factors, potentially leading to targeted preventive strategies and public health interventions.

Keywords: air pollution; central retinal artery occlusion; incidence; public health; risk factors; seasonality; stroke.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Monthly and seasonal incidence. Monthly (A) and seasonal (B) incidences were aggregated over a 15-year period and adjusted based on the varying lenghts of months. The peak incidence emerged in February (A) and winter (B), whereas the nadir was observed in June (A) and summer (B). Dashed line indicates trendline.
Figure 2
Figure 2
Air pollution and weather data. (A) Cumulative average air pollutions (NO2, O3, PM2.5, PM10), (B) precipitation (prcp) and atmospheric pressure (pres) and (C) mean temperature [mean average temperature (Tavg), mean minimum temperature (Tmin), mean maximum temperature (Tmax)] during the 15-year study period. PM2.5, PM10, and NO2 show increased concentrations in the winter months, while O3 concentration peaks in summer. The mean temperature follows a seasonal pattern, with average temperatures between 0 and 5°C in winter and around 20° in summer.
Figure 3
Figure 3
Yearly incidences of central retinal artery occlusion and corresponding yearly weather and air pollution data during study period. (A) Incidences by year from 2008 to 2022, yearly mean (B) temperature and concentrations of (C) PM2.5 and PM10, (D) NO2 and O3, and (E) mean daily precipitation and (F) mean atmospheric pressure. The formulas relate to the respective trendlines of the data curve.
See this image and copyright information in PMC

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