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Age, Gender, and Laterality of Retinal Vascular Occlusion: A Retrospective Study from the IRIS® Registry

  • Author Footnotes
    ∗ Both authors contributed equally as first authors.
    Yangjiani Li
    Footnotes
    ∗ Both authors contributed equally as first authors.
    Affiliations
    Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA

    State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
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  • Author Footnotes
    ∗ Both authors contributed equally as first authors.
    Nathan E. Hall
    Footnotes
    ∗ Both authors contributed equally as first authors.
    Affiliations
    Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA

    Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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  • Suzann Pershing
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA

    Department of Ophthalmology, VA Palo Alto Health Care System, Palo Alto, California, USA
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  • Leslie Hyman
    Affiliations
    Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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  • Julia A. Haller
    Affiliations
    Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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  • Aaron Y. Lee
    Affiliations
    eScience Institute, University of Washington, Seattle, Washington, USA

    Department of Ophthalmology, University of Washington, Seattle, Washington, USA
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  • Cecilia S. Lee
    Affiliations
    Department of Ophthalmology, University of Washington, Seattle, Washington, USA
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  • Michael Chiang
    Affiliations
    Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
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  • Flora Lum
    Affiliations
    American Academy of Ophthalmology, San Francisco, California, USA
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  • Author Footnotes
    † These authors contributed equally as senior authors.
    Joan W. Miller
    Footnotes
    † These authors contributed equally as senior authors.
    Affiliations
    Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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  • Author Footnotes
    † These authors contributed equally as senior authors.
    Alice Lorch
    Footnotes
    † These authors contributed equally as senior authors.
    Affiliations
    Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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  • Author Footnotes
    † These authors contributed equally as senior authors.
    Tobias Elze
    Correspondence
    Correspondence: Tobias Elze, PhD, Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 20 Staniford Street, Boston, MA 02114, USA.
    Footnotes
    † These authors contributed equally as senior authors.
    Affiliations
    Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Both authors contributed equally as first authors.
    † These authors contributed equally as senior authors.

      Purpose

      Retinal vascular occlusion is a leading cause of profound irreversible visual loss, but the understanding of the disease is insufficient. We systematically investigated the age, gender, and laterality at the onset of retinal artery occlusion (RAO) and retinal vein occlusion (RVO) in the Intelligent Research in Sight (IRIS®) Registry.

      Design

      Retrospective registry cohort.

      Participants

      Patients with retinal vascular occlusion participating in the IRIS® Registry.

      Methods

      Patients who received a diagnosis of retinal vascular occlusion between 2013 and 2017 were included. Those with unspecified gender or laterality were excluded when conducting the relevant analyses. Patients were categorized into RAO, with subtypes transient retinal artery occlusion (TRAO), partial retinal artery occlusion (PRAO), branch retinal artery occlusion (BRAO), and central retinal artery occlusion (CRAO), and into RVO, with subtypes venous engorgement (VE), branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO). Age was evaluated as a categorical variable (5-year increments). We investigated the association of age, gender, and laterality with the onset frequency of retinal vascular occlusion subtypes.

      Main Outcome Measures

      The frequency of onset of RAO and RVO subtypes by age, gender and laterality.

      Results

      A total of 1 251 476 patients with retinal vascular occlusion were included, 23.8% of whom had RAO, whereas 76.2% had RVO. Of these, 1 248 656 and 798 089 patients were selected for analyses relevant to gender and laterality, respectively. The onset frequency of all subtypes increased with age. PRAO, BRAO, CRAO, and CRVO presented more frequently in men (53.5%, 51.3%, 52.6%, and 50.4%, respectively), whereas TRAO, VE, and BRVO presented more frequently in women (54.9%, 56.0%, and 54.5% respectively). All RAO subtypes and BRVO showed a right-eye onset preference (TRAO, 51.7%; PRAO, 54.4%; BRAO, 53.5%; CRAO, 53.4%; and BRVO, 51.0%), whereas VE and CRVO exhibited a left-eye onset preference (53.3% and 50.9%, respectively).

      Conclusions

      Although retinal vascular occlusion incidence increases with age regardless of subtypes, we found various subtype-specific disease-onset differences related to gender and, in particular, ocular laterality. These findings may improve understanding of the specific cause of retinal vascular occlusions of different subtypes and their relationships with structural and anatomic asymmetries of the vascular system.

      Keywords

      Abbreviations and Acronyms:

      BRAO (branch retinal artery occlusion), BRVO (branch retinal vein occlusion), CRAO (central retinal artery occlusion), CRVO (central retinal vein occlusion), ICD-9 (International Classification of Diseases, Ninth Revision), ICD-10 (International Classification of Diseases, Tenth Revision), IRIS (Intelligent Research in Sight), PHRC (Partners Human Research Committee), PRAO (partial retinal artery occlusion), RAO (retinal artery occlusion), RVO (retinal vein occlusion), TRAO (transient retinal artery occlusion), VE (venous engorgement)
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