Association between primary open-angle glaucoma and retinal artery occlusions

Objective To evaluate the association between bilateral primary open-angle glaucoma (POAG) and the hazard of retinal artery occlusions (RAO), central retinal artery occlusion (CRAO), and branch retinal artery occlusion (BRAO). Design A retrospective cohort study. Subjects, participants, and/or controls Patients ≥ 40 years with bilateral POAG were compared with controls diagnosed with bilateral dry-eye-disease (DED) from the TriNetX Network (2005–2025). Methods, intervention, or testing Patients were propensity score matched 1:1 on demographic, systemic, laboratory, and ophthalmologic variables. Adjusted hazard ratios (aHRs) for CRAO, BRAO, and any RAO were estimated using Cox proportional hazards models at 1- and 3-year intervals. Results After matching, 30,318 patients were included in each group. At 1-year and 3-year follow-up, the development of any RAO was higher with POAG compared to controls (0.20% vs. 0.12%; p = 0.01, 0.33% vs. 0.13%; p < 0.01), driven primarily by BRAO (0.13% vs. 0.07%; p = 0.01, 0.24% vs. 0.07%, p < 0.01), while rates of CRAO were not significantly different. In adjusted Cox analyses, POAG had an increased hazard of any RAO (aHR 1.50; 95% confidence interval [CI] 1.02–2.21 at 1 year, and aHR 2.28; 95% CI 1.37–3.80 at 3 years) and specifically BRAO (aHR 1.73; 95% CI 1.04–2.91 at 1 year, aHR 3.18; 95% CI 1.62–6.23 at 3 years), but not CRAO. However, in sensitivity analyses, POAG had a significant hazard of developing CRAO. Conclusions Bilateral POAG was significantly associated with increased hazards of BRAO. Although CRAO was not significant in the primary analysis, sensitivity analyses suggest a potential association.