​​Almost One in Four Who Have Ischemic Ocular Events Suffer Stroke Within a Year

The significantly elevated risk in the weeks following an ischemic ocular event (such as BRAO, seen here), particularly within the first month, underscores the need for structured follow-up after a stroke work-up. The data in this study highlights that risk mitigation should also include continued clinical surveillance and counseling patients on alarm symptoms and when to seek medical attention beyond the acute management period. Photo: Rami Aboumourad, OD. Click image to enlarge. Acute ischemic monocular vision loss can often present as a warning sign for impending stroke. These ischemic ocular events include central (CRAO) and branch retinal artery occlusion (BRAO) along with amaurosis fugax. RAO results in permanent monocular vision loss, while amaurosis fugax causes transient visual episodes. These events require immediate attention and prompt action not just from eyecare providers, but medical professionals at emergency rooms.  A large-scale electronic health record (EHR) database offers an opportunity to address these problems in modeling stroke risk among patients who have suffered ischemic ocular events.In a recent study published in Ophthalmology Retina, researchers used EHR data from a five-year period to investigate clinical characteristics that impact ischemic stroke or transient ischemic attack risk following the first RAO or amaurosis fugax among adult patients. They found that the highest risk of an event is immediately following the IOE; however, patients may remain at elevated risk for several weeks.“Close follow-up beyond prompt initial evaluation may be indicated, especially in the presence of several clinical factors, particularly older age, hypertension, underlying cardiovascular disease, and carotid artery stenosis,” the study authors suggested in their paper. “Among patients without obvious risk factors, referral for age-appropriate health screenings can allow for more comprehensive risk stratification and preventative measures.”Of 11,297 individuals with an ischemic ocular event (mean age 69.7 years; 53.7% female), 1,548 (13.5%) had an ischemic stroke, 1,231 had a transient ischemic attack (10.9%) and 22.8% had an ischemic stroke and/or transient ischemic attack (combined analysis). This composite outcome occurred on the same day as the ischemic ocular event in 9.4% of individuals.In the combined analysis, older age (odds ratio [OR] every 10 years: 1.11), hypertension (OR: 1.99), cardiovascular disease without history of myocardial infarction (OR: 1.89) and carotid artery stenosis (OR: 1.60) carried increased risk for ischemic stroke and/or transient ischemic attack when adjusting for other characteristics. In the ischemic stroke cohort, older age (OR every 10 years: 1.11), carotid artery stenosis (OR: 1.75) and hypertension (OR: 1.36) also carry increased risk, along with ischemic heart disease (OR: 1.23) and peripheral vascular disease (OR: 1.18). In the transient ischemic attack cohort, older age (OR every 10 years: 1.11), cardiovascular disease without history of myocardial infarction (OR: 4.88), and CAS (OR: 1.46) were associated with greater risk.The researchers believe that future studies may elucidate the impact and timeline of interventions, such as medication usage and procedures such as carotid endarterectomy, on stroke risk in patients who have suffered an ischemic ocular event. The impact of other non-biological risk factors, including economic, geographic and social variables, may be also studied to identify their impact on long-term outcomes.Click here for the journal source. Vought V, Vought R, Yu Z, et al. Stroke risk after ischemic ocular events: a real-world study of an electronic health record database. Ophthalmol Retina. March 20, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.