TOPLINE

Patients with varicose veins were about twice as likely as matched peers without the condition to be diagnosed with central serous chorioretinopathy, a condition in which fluid builds up under the retina. This association persisted after excluding glucocorticoid users and matching for known risk factors, lending support to the idea that systemic venous dysfunction may contribute to this eye disease.

METHODOLOGY

• Researchers analyzed de-identified electronic health records from a large global network to assess whether varicose veins are linked to a later diagnosis of central serous chorioretinopathy.
• They included 621,513 patients with varicose veins (mean age, 55.8 years; 60.1% women) and an equal number of matched control individuals (matched on age, sex, race, and ethnicity); all had a general adult medical examination and no prior diagnosis of central serous chorioretinopathy or serous pigment epithelial detachment.
• To account for steroid exposure, they conducted a secondary analysis by excluding patients with any history of glucocorticoid use; 122,197 patients with varicose veins (mean age, 52.1 years; 53.6% women) were included and compared with an equal number of matched control individuals. These groups were additionally matched for healthcare use, hypertension, and sleep apnea.
• Further analysis compared the rates of deep vein thrombosis and pulmonary embolism among those with varicose veins with and without central serous chorioretinopathy.
• The main outcome was a new diagnosis of central serous chorioretinopathy or serous pigment epithelial detachment after the medical examination.

TAKEAWAY

• Patients with varicose veins were about twice as likely as the matched control individuals to receive a subsequent diagnosis of central serous chorioretinopathy (risk ratio [RR], 2.16; P < .0001). Serous pigment epithelial detachment was also diagnosed more often in patients with varicose veins (RR, 1.97; P < .0001).
• The association persisted for central serous chorioretinopathy (RR, 1.83; P = .003) and serous pigment epithelial detachment (RR, 1.95; P = .013) in the secondary analysis.
• In an analysis restricted to patients aged 18-60 years intended to avoid misclassification with age-related macular degeneration, the association remained significant for both central serous chorioretinopathy and serous pigment epithelial detachment.
• Among patients with varicose veins, those with and without central serous chorioretinopathy showed no significant differences in the rates of deep vein thrombosis (P = .078) or pulmonary embolism (P = .14).

IN PRACTICE

"These findings are consistent with prior genetic studies implicating shared endothelial pathways," the researchers reported.

SOURCE

The study was led by Bertan Cakir, of the Byers Eye Institute, Stanford University School of Medicine in Palo Alto, California. It was published online on October 7 in the British Journal of Ophthalmology.

LIMITATIONS

The analysis relied on diagnostic codes, so central serous chorioretinopathy may have been miscoded or confused with age-related macular degeneration. Mild varicose vein disease may have gone uncoded, and acute and chronic central serous chorioretinopathy could not be separated. Patients with varicose veins may have had more healthcare contact and thus more chances to have the eye condition detected. The thromboembolic analysis was underpowered and did not adjust for major risk factors such as BMI, smoking, cancer history, and use of hormonal medications. 

DISCLOSURES

The study was supported by grants from the National Eye Institute, the E. Matilda Ziegler Foundation for the Blind, and Research to Prevent Blindness, Inc. One author reported financial support, consulting fees, travel support, and stock options in certain companies. Another author is a named inventor on a provisional patent application related to medications for central serous chorioretinopathy treatment. 

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