What is the relationship between central retinal vein occlusion and atrial fibrillation (AFib)?

From the Guidelines

Central retinal vein occlusion (CRVO) is associated with atrial fibrillation (AFib) due to the increased risk of thromboembolism, and management should prioritize anticoagulation therapy and addressing underlying cardiovascular risk factors 1.

Key Considerations

• The relationship between CRVO and AFib is rooted in the hypercoagulable state of AFib, which can lead to thrombus formation and subsequent occlusion of the central retinal vein.
• Risk factors for CRVO, including hypertension, diabetes, and hyperlipidemia, should be optimized to reduce the risk of cardiovascular events and mortality 1.
• Anticoagulation therapy, such as warfarin or direct oral anticoagulants (DOACs), is essential in managing CRVO associated with AFib, with the choice of therapy depending on patient factors such as renal function and medication interactions.
• Intravitreal anti-VEGF injections may be used to reduce macular edema and improve vision in patients with CRVO, and prompt ophthalmology referral is crucial for timely management.

Management Strategies

• Anticoagulation therapy should be initiated promptly in patients with CRVO and AFib, with a target INR of 2-3 for warfarin or the recommended dose for DOACs 1.
• Addressing underlying cardiovascular risk factors, such as hypertension and diabetes, is crucial in reducing the risk of cardiovascular events and mortality.
• Intravitreal anti-VEGF injections, such as bevacizumab, ranibizumab, or aflibercept, may be used to reduce macular edema and improve vision in patients with CRVO.
• Prompt ophthalmology referral, ideally within 1-2 weeks of symptom onset, is essential for timely management and reducing the risk of complications.

From the Research

Relationship between Central Retinal Vein Occlusion and Atrial Fibrillation

There is limited direct evidence on the relationship between central retinal vein occlusion (CRVO) and atrial fibrillation (AFib). However, some studies provide insight into the relationship between retinal vascular disorders and AFib:

• Central retinal artery occlusion (CRAO) has been associated with AFib, as seen in studies 2, 3, 4.
• CRAO is considered a high-risk condition for AFib, with new-onset AF diagnosed in 12.6% of patients with CRAO 2.
• The management of CRAO should focus on secondary prevention of vascular events, including cerebral ischemia, myocardial infarction, and cardiovascular death, which are also risk factors for AFib 5.
• Cardioversion of AFib can lead to thromboembolic complications, including CRAO 4.
• There is no direct evidence on the relationship between CRVO and AFib in the provided studies, but CRVO is a common retinal vascular disorder that can result in severe visual acuity loss 6.

Key Findings

• CRAO is associated with AFib and is a high-risk condition for new-onset AF.
• Management of CRAO should focus on secondary prevention of vascular events.
• Cardioversion of AFib can lead to thromboembolic complications, including CRAO.
• CRVO is a common retinal vascular disorder, but its direct relationship with AFib is not established in the provided studies.