The present study evaluated the changes in retinal vascular structure among patients with retinal vein occlusion (RVO) according to varying cardiovascular risk (CVR) scores. We analyzed clinical data, blood tests, ophthalmic exams, and macular vascular parameters measured with optical coherence tomography angiography (OCTA) and CVR scores. This study included 21 patients with central retinal vein occlusion (CRVO), 35 patients with branch retinal vein occlusion (BRVO), and 60 control subjects with refractive disorders and no other abnormalities. In eyes with RVO, macular vascular densities in the superficial capillary plexus were significantly lower in all quadrants compared with controls (P < .05), while in the deep capillary plexus, significant reductions were observed in all quadrants except the nasal quadrant (P < .05). Both superficial and deep foveal avascular zone (FAZ) areas were significantly larger in RVO eyes compared with the control group (P < .001 for all). CVR scores were significantly higher in RVO patients compared with the control group (P < .001 for all). CVR scores were highest in CRVO patients (P < .001). Deep FAZ areas showed positive correlations with CVR scores. The present findings suggest that cardiovascular disease risk should be assessed in patients with RVO.
WongTYScottIU.Clinical practice. Retinal-vein occlusion. N Engl J Med. 2010;363:2135-2144. doi:10.1056/NEJMcp1003934
2.
RogersSMcIntoshRLCheungN, et al. The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology. 2010;117:313-319.e311. doi:10.1016/j.ophtha.2009.07.017
3.
BudzinskayaMVMazurinaNKEgorovAE, et al. Retinal vein occlusion management algorithm. Part 1. Classification, diagnosis, and acute-stage treatment. Vestn Oftalmol. 2015;131:51-56. doi:10.17116/oftalma2015131651-56
4.
ØrskovMVorumHBjerregaard LarsenT, et al. A review of risk factors for retinal vein occlusions. Expert Rev Cardiovasc Ther. 2022;20:761-772. doi:10.1080/14779072.2022.2112667
5.
YinXLiJZhangBLuP.Association of glaucoma with risk of retinal vein occlusion: a meta-analysis. Acta Ophthalmol. 2019;97:652-659. doi:10.1111/aos.14141
6.
LeeJHKimSHKimE.Influence of smoking and controlled medical conditions on the risks of branch retinal vein occlusion in South Korea: a population-based study. Ophthalmic Epidemiol. 2025;32(1):44-51. doi:10.1080/09286586.2024.2321902
7.
TsaloumasMDKirwanJVinallH, et al. Nine year follow-up study of morbidity and mortality in retinal vein occlusion. Eye (Lond). 2000;14:821-827. doi:10.1038/eye.2000.230.
8.
ZhongCYouSZhongXChenG-CXuTZhangY.Retinal vein occlusion and risk of cerebrovascular disease and myocardial infarction: a meta-analysis of cohort studies. Atherosclerosis. 2016;247:170-176. doi:10.1016/j.atherosclerosis.2016.02.024
9.
WilsonPWD’AgostinoRBLevyDBelangerAMSilbershatzHKannelWB.Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837-1847. doi:10.1161/01.cir.97.18.1837
10.
GoffDCJrLloyd-JonesDMBennettG, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49-S73. doi:10.1161/01.cir.0000437741.48606.98
11.
KarakayalıMPüşüroğluHAltunovaMYılmazEGüllüA.Predictive value of the SCORE, SCORE2, and pooled cohort risk equation systems in patients with hypertension. Turk Kardiyol Dern Ars. 2023;51:407-414. doi:10.5543/tkda.2023.74249
12.
KhanZAlmeidaDRRahimKBelliveauMJBonaMGaleJ.10-year Framingham risk in patients with retinal vein occlusion: a systematic review and meta-analysis. Can J Ophthalmol. 2013;4840-45.e41. doi:10.1016/j.jcjo.2012.08.017
13.
MartinSCButcherAMartinN, et al. Cardiovascular risk assessment in patients with retinal vein occlusion. Br J Ophthalmol. 2002;86:774-776. doi:10.1136/bjo.86.7.774
14.
SpaideRFKlancnikJMJrCooneyMJ.Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol. 2015;133:45-50. doi:10.1001/jamaophthalmol.2014.3616
15.
Argon laser scatter photocoagulation for prevention of neovascularization and vitreous hemorrhage in branch vein occlusion. A randomized clinical trial. Branch Vein Occlusion Study Group. Arch Ophthalmol. 1986;104:34-41. doi:10.1001/archopht.1986.01050130044017
16.
Natural history and clinical management of central retinal vein occlusion. The central vein occlusion study group. Arch Ophthalmol. 1997;115:486-491. doi:10.1001/archopht.1997.01100150488006
17.
Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol. 1985;103:1796-1806.
18.
SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J. 2021;42:2439-2454. doi:10.1093/eurheartj/ehab309
19.
SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe. Eur Heart J. 2023;44:2544-2556. doi:10.1093/eurheartj/ehad260
20.
World Health Statistics. Monitoring health for the SDGs, sustainable development goals. WHO;2023.
21.
CugatiSWangJJKnudtsonMD, et al. Retinal vein occlusion and vascular mortality: pooled data analysis of 2 population-based cohorts. Ophthalmology. 2007;114:520-524. doi:10.1016/j.ophtha.2006.06.061
22.
ChristoffersenNGadeEKnudsenLJuelKLarsenM.Mortality in patients with branch retinal vein occlusion. Ophthalmology. 2007;114:1186-1189. doi:10.1016/j.ophtha.2007.01.031
23.
Joint British recommendations on prevention of coronary heart disease in clinical practice. British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, endorsed by the British Diabetic Association. Heart. 1998;80(suppl 2):S1-S29.
24.
FanLZhuYLiaoR.Evaluation of macular microvasculature and foveal avascular zone in patients with retinal vein occlusion using optical coherence tomography angiography. Int Ophthalmol. 2022;42:211-218. doi:10.1007/s10792-021-02015-5
25.
WakabayashiTSatoTHara-UenoC, et al. Retinal microvasculature and visual acuity in eyes with branch retinal vein occlusion: imaging analysis by optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2017;58:2087-2094. doi:10.1167/iovs.16-21208
26.
ÇalışkanNEDoğanMÇalışkanAGobekaHHAyİE.Optical coherence tomography angiography evaluation of retinal and optic disc microvascular morphological characteristics in retinal vein occlusion. Photodiagnosis Photodyn Ther. 2023;41:103244. doi:10.1016/j.pdpdt.2022.103244
27.
FreundKBSarrafDLeongBCSGarritySTVupparaboinaKKDansinganiKK.Association of optical coherence tomography angiography of collaterals in retinal vein occlusion with major venous outflow through the deep vascular complex. JAMA Ophthalmol. 2018;136:1262-1270. doi:10.1001/jamaophthalmol.2018.3586
28.
FalavarjaniKGPhasukkijwatanaNFreundKB, et al. En face optical coherence tomography analysis to assess the spectrum of perivenular ischemia and paracentral acute middle maculopathy in retinal vein occlusion. Am J Ophthalmol. 2017;177:131-138. doi:10.1016/j.ajo.2017.02.015
29.
PaquesMGaudricA.Perivenular macular whitening during acute central retinal vein occlusion. Arch Ophthalmol. 2003;121:1488-1491. doi:10.1001/archopht.121.10.1488
30.
KellnerRLHarrisACiullaL, et al. The eye as the window to the heart: optical coherence tomography angiography biomarkers as indicators of cardiovascular disease. J Clin Med. 2024;13:829. doi:10.3390/jcm13030829
31.
ChristouEEKostikasKAsproudisCZafeiropoulosPStefaniotouMAsproudisI.Retinal microcirculation characteristics in obstructive sleep apnea/hypopnea syndrome evaluated by OCT-angiography: a literature review. Int Ophthalmol. 2022;42:3977-3991. doi:10.1007/s10792-022-02361-y
32.
RispoliMSavastanoMCLumbrosoB.Capillary network anomalies in branch retinal vein occlusion on optical coherence tomography angiography. Retina. 2015;35:2332-2338. doi:10.1097/iae.0000000000000845
33.
OuederniMKhalifaMBHSassiHNefaaFAyedOCheourM.Quantitative analysis of microvascular network with optical coherence tomography angiography and its correlation with visual acuity in retinal vein occlusion. J Curr Ophthalmol. 2021;33:453-460. doi:10.4103/joco.joco_163_21
34.
WonsJPfauMWirthMAFreibergFJBeckerMDMichelsS.Optical coherence tomography angiography of the foveal avascular zone in retinal vein occlusion. Ophthalmologica. 2016;235:195-202. doi:10.1159/000445482
35.
SuzukiNHiranoYTomiyasuT, et al. Retinal hemodynamics seen on optical coherence tomography angiography before and after treatment of retinal vein occlusion. Invest Ophthalmol Vis Sci. 2016;57:5681-5687. doi:10.1167/iovs-16-20648
36.
TsaiGBanaeeTContiFFSinghRP.Optical coherence tomography angiography in eyes with retinal vein occlusion. J Ophthalmic Vis Res. 2018;13:315-332. doi:10.4103/jovr.jovr_264_17
37.
MastropasquaRTotoLDi AntonioL, et al. Optical coherence tomography angiography microvascular findings in macular edema due to central and branch retinal vein occlusions. Sci Rep. 2017;7:40763. doi:10.1038/srep40763
38.
KoulisisNKimAYChuZ, et al. Quantitative microvascular analysis of retinal venous occlusions by spectral domain optical coherence tomography angiography. PLoS One. 2017;12:e0176404. doi:10.1371/journal.pone.0176404
39.
PacellaFBongiovanniGMalvasiM, et al. Impact of cardiovascular risk factors on incidence and severity of Retinal Vein Occlusion. Clin Ter. 2020;171:e534-e538. doi:10.7417/ct.2020.2269.
40.
UmeyaRYoshidaYOnoK.Impact of retinal vein occlusion on cardiovascular events in elderly Japanese patients. Medicine (Baltimore). 2021;100:e28424. doi:10.1097/md.0000000000028424
41.
FrederiksenKHStokholmLFrederiksenPH, et al. Cardiovascular morbidity and all-cause mortality in patients with retinal vein occlusion: a Danish nationwide cohort study. Br J Ophthalmol. 2023;107:1324-1330. doi:10.1136/bjophthalmol-2022-321225
42.
BertelsenMLinnebergAChristoffersenNVorumHGadeELarsenM.Mortality in patients with central retinal vein occlusion. Ophthalmology. 2014;121:637-642. doi:10.1016/j.ophtha.2013.07.025
43.
ChenYYSheuSJHuHY, et al. Association between retinal vein occlusion and an increased risk of acute myocardial infarction: a nationwide population-based follow-up study. PLoS One. 2017;12:e0184016. doi:10.1371/journal.pone.0184016
44.
Risk factors for central retinal vein occlusion. The eye disease case-control study group. Arch Ophthalmol. 1996;114:545-554
45.
KarimzadSEShokrHGherghelD.Retinal and peripheral vascular function in healthy individuals with low cardiovascular risk. Microvasc Res. 2019;126:103908. doi:10.1016/j.mvr.2019.103908
46.
WangJJLiewGWongTY, et al. Retinal vascular calibre and the risk of coronary heart disease-related death. Heart. 2006;92:1583-1587. doi:10.1136/hrt.2006.090522
47.
WongTYKleinRKleinBETielschJMHubbardLNietoFJ.Retinal microvascular abnormalities and their relationship with hypertension, cardiovascular disease, and mortality. Surv Ophthalmol. 2001;46:59-80. doi:10.1016/s0039-6257(01)00234-x
48.
OwenCGRudnickaARWelikalaRA, et al. Retinal vasculometry associations with cardiometabolic risk factors in the European Prospective Investigation of Cancer-Norfolk Study. Ophthalmology. 2019;126:96-106. doi:10.1016/j.ophtha.2018.07.022
49.
FalavarjaniKGShenazandiHNaseriD, et al. Foveal avascular zone and vessel density in healthy subjects: an optical coherence tomography angiography study. J Ophthalmic Vis Res. 2018;13:260-265. doi:10.4103/jovr.jovr_173_17
50.
CohnJN.Identifying the risk and preventing the consequences of cardiovascular disease. Heart Lung Circ. 2013;22:512-516. doi:10.1016/j.hlc.2013.03.083
51.
SeshadriSMroczkowskaSQinLPatelSEkartAGherghelD.Systemic circulatory influences on retinal microvascular function in middle-age individuals with low to moderate cardiovascular risk. Acta Ophthalmol. 2015;93:e266-274. doi:10.1111/aos.12594
52.
GargNMuduliSKKapoorA, et al. Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recommended statin uses. Indian Heart J. 2017;69:458-463. doi:10.1016/j.ihj.2017.01.015
53.
Hasani-RanjbarSRazmandehRGhodssi-GhassemabadiRKhodabakhshiMEbrahimpourM.Comparison of Framingham cardiovascular risk criteria and ASCVD score in Iranian obese patients. Iran J Public Health. 2023;52:420-426. doi:10.18502/ijph.v52i2.11895
