Study identifies stroke risks following ischemic ocular events

Ischemic ocular events carry neurologic implications that go well beyond vision.

And while retinal artery occlusion (RAO) and amaurosis fugax have long been treated as red flags for stroke risk, clinicians still have limited real-world data on which patients are most vulnerable after that first event.

As such: A new study in Ophthalmology Retina used a large U.S. electronic health record (EHR) database to:

• Examine 1-year stroke and transient ischemic attack (TIA) risk after these events
• Identify which baseline clinical factors were associated with higher odds of a cerebral ischemic event

The findings reinforce the urgency of acute evaluation, but they also suggest that the period of concern does not end once the initial stroke workup is complete.

Start with the basics: Why are these events treated as stroke warning signs?

Acute vision loss in one eye is often treated as a warning sign for stroke. RAO can cause sudden and permanent loss of vision, while amaurosis fugax usually leads to brief, temporary episodes.

Even though they present differently, both are linked to a higher risk of stroke in the short term. Current guidelines recommend urgent evaluation at a stroke center for these events.

This level of urgency comes from earlier research showing that stroke risk increases around the time of the ocular event, especially in the days and weeks that follow retinal artery occlusion.

What gap was this study trying to address?

Previous research had already linked ischemic ocular events with later stroke and TIA, but risk estimates varied widely across studies—and most risk models were built from relatively small retrospective cohorts or administrative datasets.

The authors specifically wanted to look beyond the first few days after the event and use a larger real-world EHR dataset to study 1-year event rates and baseline risk factors in a more diverse U.S. population.

Now for the new research.

This was a case-control study using structured EHR data from Truveta, a national database representing roughly 120 million patients across more than 30 U.S. health systems.

The investigators identified adults with an incident ischemic ocular event between Jan. 1, 2019, and Sept. 30, 2024, then examined whether they developed ischemic stroke, TIA, or either event within 1 year.

They used logistic regression to estimate the odds associated with baseline demographics and comorbidities present before or on the same day as the ocular event.

Who was included in the study?

The primary analysis included 11,297 adults with an incident ischemic ocular event, defined as RAO or amaurosis fugax.

• Mean age: 69.7 years
• 53.7% of patients were female
• Exclusions: Patients with prior stroke or TIA (to ensure only new events were captured)

How often did stroke or TIA occur after an ischemic ocular event?

Within 1 year, 13.5% of patients had an ischemic stroke, 10.9% had a TIA, and 22.8% had either ischemic stroke or TIA.

Notably: 9.4% experienced one of these events on the same day as the ocular event.

Which baseline risk factors were linked to higher stroke risk?

After adjustment: Older age, hypertension, cardiovascular disease, and carotid artery stenosis were all associated with increased odds of stroke or TIA.

These associations align with established vascular risk models, particularly the role of carotid artery disease as a source of embolic events affecting both the retina and brain.

Any study limitations?

As with most EHR-based studies, results depended on accurate coding and complete data capture.

• Events that occurred outside participating systems may not have been recorded, and some behavioral risk factors, such as smoking, were not consistently available.

Additionally, combining RAO and amaurosis fugax into a single category may obscure differences in risk profiles between these conditions.

What do these findings mean for follow-up after ROA or amaurosis fugax?

The clinical takeaway is that immediate stroke workup is necessary, but not sufficient.

Risk remains elevated after the initial event, particularly in patients with underlying cardiovascular disease or carotid pathology.

This supports a more structured follow-up approach, including continued monitoring and coordination with primary care and neurology rather than treating the event as resolved after acute evaluation.

And what questions still remain about prevention and risk stratification?

While the study identifies high-risk groups, it does not determine which interventions most effectively reduce post-event stroke risk.

Future research will need to evaluate how treatments such as antiplatelet therapy, statins, or carotid interventions influence outcomes in this population.