Risk of dementia following retinal vascular occlusions: A propensity-score matched cohort study using a global federated database

OBJECTIVE: Retinal vascular occlusions (RVaO), including retinal artery occlusion (RAO) and retinal vein occlusion (RVO), are common retinal vascular disorders that may indicate systemic vascular disease and cerebral microvascular pathology. This study investigated the association between RVaO and incident dementia, including all-cause, degenerative, and vascular dementia, and explored differences across RVaO subtypes. METHODS: This retrospective cohort study used the TriNetX database to compare 81,432 propensity score-matched pairs of patients with RVaO and cataract, employing 1:1 matching to adjust for confounders like demographics, comorbidities, and medications. Five-year dementia risk was evaluated with Kaplan-Meier and Cox models in matched groups. Additional multivariable Cox regression identified independent predictors in the RVaO cohort, and subgroup analyses examined differences by age, sex, and RVaO subtype. RESULTS: The RVaO cohort had significantly higher five-year risks compared to the cataract cohort, with hazard ratios of 1.15 (95% confidence interval [CI], 1.09-1.22) for all-cause dementia, 1.13 (95% CI, 1.06-1.19) for degenerative dementia, and 1.30 (95% CI, 1.16-1.47) for vascular dementia. The association was consistent across patients aged ≥65 years and both sexes. RVO showed stronger associations than RAO across all dementia subtypes. Multivariable analysis identified age, nicotine dependence, hypertension, and chronic kidney disease as independent predictors of dementia in RVaO patients. CONCLUSIONS: RVaO is associated with an increased dementia risk, particularly vascular dementia, with RVO showing more consistent associations than RAO. Although the associations were statistically significant, the effect size was small, and the results should be viewed as associative rather than causal.