Risk of retinal artery occlusion in patients with primary open-angle glaucoma: a retrospective cohort study

Background: To evaluate the risk of Retinal Artery Occlusion (RAO) in individuals with Primary-Open Angle Glaucoma (POAG) using a large-scale real-world database. Methods: This retrospective cohort study used the TriNetX Global Collaborative Network to analyze electronic health records from 145 healthcare organizations. Adults aged 18 years or older with POAG were compared with non-POAG controls. Propensity score matching (PSM) was performed 1:1 on 10 baseline characteristics. The primary outcome was incident RAO occurring from one day after the index POAG diagnosis up to 5 years of follow-up. Hazard ratios (HRs) were calculated using Cox proportional hazard models. Kaplan-Meier analysis was conducted to compare RAO-free survival using log-rank tests. Results: After PSM, there were 260,677 patients in each cohort (50.9% female; mean age 68.2 years). POAG patients had a significantly increased risk of RAO compared with controls (3.46 vs. 1.94 per 10,000; HR 2.16; 95% CI, 1.94–2.42; p <.001). The association persisted in sex-stratified and extended follow-up analyses. Anti-glaucoma medications did not significantly alter risk. Conclusions: This large-scale cohort study identifies POAG as an independently associated risk marker for RAO. These findings highlight the importance of vascular risk assessment in POAG management and highlight the need for increased vigilance for retinal ischemic events in this population.