Central retinal artery occlusion: meta-analysis of the risk of new-onset atrial fibrillation and ischemic stroke

Background Central retinal artery occlusion (CRAO) causes irreversible blindness. Atrial fibrillation (AF) is a recognized cause that may not be present at the time of the event. Objective We aimed to assess the relation of CRAO with new-onset AF and ischemic stroke. Methods We systematically searched the literature, utilizing the search terms “atrial fibrillation” and “retinal artery occlusion”. We used a random effects model to calculate the pooled odds ratio (OR) and 95% confidence intervals (CI) of new-onset AF risk and new-onset ischemic stroke risk in CRAO patients compared to matched controls, as well as the new-onset AF risk compared to ischemic stroke patients. Analysis was performed with Rev-Man 5.4.1. Results We included 1479 patients with CRAO, 9843 matched controls without CRAO and stroke at baseline, and 7058 patients with ischemic stroke for meta-analysis. There were 115 cases of new-onset AF (14%) during a follow-up of 34 months. CRAO was associated with a higher risk for new-onset AF (OR:1.47, 95% CI:1.18–1.83; p = 0.0006) and new ischemic stroke (OR:2.10, 95% CI:1.57–2.82; p < 0.00001) when compared to control patients. The risk of new-onset AF after CRAO was similar to that observed after ischemic stroke (OR:0.80, 95% CI:0.40–1.61; p = 0.54). Follow-up duration and timing of outcome detection varied. Conclusion CRAO is associated with a higher risk of new-onset AF and ischemic stroke. The risk of AF after CRAO is similar to that after an ischemic stroke. Thus, CRAO may be seen as a stroke-equivalent prompting closer follow-up with screening and eventually anticoagulation.