Retinal vein occlusion (RVO) has long been recognized as a leading cause of visual impairment, second only to diabetic retinopathy. But new research from the Gutenberg Health Study (GHS) suggests that its implications may reach far beyond the eye—potentially signaling elevated mortality risk.
📍 A European First: Incidence in the General Population
The GHS, a large-scale population-based cohort study in Germany, offers the first robust data on RVO incidence in a European population. Over 10 years, researchers tracked 12,954 participants aged 35–74 using fundus imaging and infrared photography. Their findings:
- Branch RVO (BRVO): 10-year cumulative incidence of 0.64%
- Central RVO (CRVO): 10-year cumulative incidence of 0.14%
These rates are notably lower than those reported in other regions. For example, the Beaver Dam Eye Study in the U.S. found a 15-year incidence of 1.8% for BRVO and 0.5% for CRVO (Klein et al., 2008), while Japan’s Hisayama Study reported a 9-year incidence of 3.0% for any RVO (Arakawa et al., 2011).
🧬 Risk Factors: Age Stands Alone
Initial univariable analysis linked RVO to several cardiovascular risk factors—hypertension, diabetes, dyslipidemia, and family history of stroke or myocardial infarction. However, multivariable regression revealed a sobering truth: age was the only consistent predictor.
This finding aligns with global data. A meta-analysis by Song et al. (2019) showed RVO prevalence rising sharply with age, from 0.26% in those aged 30–39 to 3.39% in those 80–89.
⚰️ Mortality: A Hidden Signal?
Perhaps the most striking revelation from the GHS is the link between RVO and mortality. After adjusting for cardiovascular risk factors, researchers found:
- BRVO: Hazard Ratio (HR) 2.27 (95% CI: 1.08–3.0)
- CRVO: HR 3.83 (95% CI: 1.95–7.9)
These results suggest that RVO—especially CRVO—may serve as a marker for systemic vascular vulnerability. Previous studies have offered mixed conclusions. A Danish nationwide cohort found increased mortality only in CRVO cases (Frederiksen et al., 2023), while others failed to differentiate between RVO subtypes or lacked rigorous adjustment for confounders.
🧾 Why It Matters
The GHS findings challenge clinicians to rethink RVO not just as an ocular event, but as a potential red flag for broader health risks. With age as the dominant factor and mortality risk elevated even after controlling for comorbidities, RVO may warrant closer systemic evaluation.
As Dr. Anna Maria Voigt and colleagues conclude, “Participants with BRVO and CRVO have an increased mortality after RVO independently of major cardiovascular risk factors” (Voigt et al., 2025).
📚 References
- Voigt AM et al. Incidence of Retinal Vein Occlusion and Its Association with Mortality: Results from the Gutenberg Health Study. Ophthalmology. 2025;132:869–877. https://doi.org/10.1016/j.ophtha.2025.02.007
- Song P et al. Global epidemiology of retinal vein occlusion: a systematic review and meta-analysis. J Glob Health. 2019;9(1):010427.
- Arakawa S et al. Nine-year incidence and risk factors for retinal vein occlusion: the Hisayama Study. Invest Ophthalmol Vis Sci. 2011;52(8):5906.
- Klein R et al. The 15-year cumulative incidence of retinal vein occlusion: the Beaver Dam Eye Study. Arch Ophthalmol. 2008;126(4):515–516.
- Frederiksen KH et al. Cardiovascular morbidity and all-cause mortality in patients with retinal vein occlusion: a Danish nationwide cohort study. Br J Ophthalmol. 2023;107(9):1326.
