The hidden primary glaucoma in retinal vein occlusion: a call for systematic screening

To investigate the epidemiological characteristics of primary glaucoma in patients with retinal vein occlusion (RVO), providing evidence-based insights for clinical diagnosis and management. This retrospective study included patients diagnosed with RVO at the Department of Ophthalmology, Zhongnan Hospital of Wuhan University, from January 2018 to April 2024. Primary glaucoma screening followed a two-step protocol: (1) preliminary evaluation using existing ophthalmic records; and (2) confirmatory testing with additional examinations for suspected cases. Among 610 enrolled RVO patients, 94 (15.4%) were diagnosed with primary glaucoma, including 9.2% (56/610) with primary open-angle glaucoma, 6.2% (38/610) with primary angle-closure glaucoma. Of the primary glaucoma cases, 43/94 (45.7%) were previously undiagnosed, consisting of 37 primary open-angle glaucoma (including 20 normal-tension glaucoma) and 6 chronic angle-closure glaucoma. This study demonstrates a high prevalence of primary glaucoma—particularly normal-tension glaucoma—in patients with RVO compared to the general population, with nearly half of cases previously undiagnosed. These observations highlight the importance of clinical awareness and the potential benefit of glaucoma screening in this population. However, given the observational design, prospective studies are needed to confirm the value of systematic screening before practice-level recommendations can be made.