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TOPLINE:

A meta-analysis of 11 studies involving more than 502 million individuals revealed that those with retinal artery occlusion had a notably higher risk for acute coronary syndrome and all-cause mortality than individuals without the condition. The risk for adverse cardiac events was more pronounced in patients with central retinal artery occlusion than in those with branch retinal artery occlusion, and it was also increased in those with comorbidities such as atrial fibrillation.

METHODOLOGY:

• Researchers conducted a meta-analysis to understand the association between retinal artery occlusion and the risk for acute coronary syndrome and all-cause mortality.
• They included 11 retrospective cohort studies published between 2015 and 2023 with more than 502 million participants across Asian, European, and American populations; retinal artery occlusion was present in 94,410 individuals, and the remaining participants comprised the control group.
• These studies reported the incidence of acute coronary syndrome (eg, myocardial infarction and unstable angina) or all-cause mortality after a diagnosis of retinal artery occlusion.
• Subgroup analyses assessed differences in risk by type of retinal artery occlusion, geographic region, and the presence of comorbidities such as atrial fibrillation, hypertension, hyperlipidemia, and diabetes.

TAKEAWAY:

• Retinal artery occlusion was associated with a 1.56-fold increased risk for acute coronary syndrome (relative risk [RR], 1.56; 95% CI, 1.22-1.99) and a twofold increased risk for all-cause mortality (RR, 2.00; 95% CI, 1.22-3.28).
• Subgroup analyses showed that patients with central retinal artery occlusion and Asian populations had higher risks for both acute coronary syndrome and mortality than those with branch retinal artery occlusion and non-Asian populations, respectively.
• Among comorbidities, atrial fibrillation was the strongest predictor of subsequent events of acute coronary syndrome (RR, 2.46; 95% CI, 1.34-4.54), followed by hypertension (RR, 1.99; 95% CI, 1.31-3.03), hyperlipidemia (RR, 1.86; 95% CI, 1.42-2.44), and diabetes (RR, 1.65; 95% CI, 1.11-2.46).

IN PRACTICE:

Retinal artery occlusion “may serve as a sentinel event or risk marker — rather than a direct etiologic factor — of systemic vascular disease,” the researchers reported.

They also advocated “the critical need for comprehensive cardiovascular assessment” in the patient population.

SOURCE:

The study was led by Erfan Hashemi of the Department of Surgery at the University of Calgary in Calgary, Alberta, Canada. It was published online on August 21, 2025, in American Journal of Ophthalmology.

LIMITATIONS:

The observational nature of the included studies limited concluding if retinal artery occlusion actually increased the risk for acute coronary syndrome. The possibility that some unmeasured confounders biased the results could not be ruled out completely. 

DISCLOSURES:

This study did not receive any funding. The authors reported having no relevant conflicts of interest. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.