Glaucoma Risk May Be Underdiagnosed in Patients with Retinal Vein Occlusions

David Ramsey, MD

New findings suggest patients with retinal vein occlusions (RVO) have higher rates of diagnosed glaucoma when compared to a reference group with bilateral dry eye syndrome (DES).

However, in contrast, RVO patients with clinical findings associated with glaucoma risk are often not coded as suspects for glaucoma.

“Reviewing billing records for clinical risk criteria associated with glaucoma implies that there may be an underdiagnosis of glaucoma risk in patients with both BRVOs and CRVOs,” wrote study author David Ramsey, MD, PhD, MPH, Lahey Hospital and Medical Center.

These findings were presented at the Association for Research in Vision and Ophthalmology (ARVO) 2022 Meeting in Denver, Colorado.

The current study compared the rate of glaucoma-related diagnoses in individuals with branch RVOs (BRVOs) or central RVOS (CRVOs) with the rate in patients without RVOs. Investigators identified patients with RVOs from billing records from 2016 to 2020.

These individuals were then compared to a reference group with bilateral DES and age- and gender-matched 2:1 to the patients with RVOs. They were classified by subtypes of glaucoma.

The records of patients without known glaucoma-related diagnoses were evaluated for potential underdiagnosis, utilizing criteria of intraocular pressure (IOP) ≥22mm Hg and/or cup-to-disc ratio (CDR) ≥0.6 and/or CDR difference between eyes ≥0.2.

A total of 643 patients were identified with RVOs, consisting of 376 patients with BRVOs and 278 patients with CRVOs. They found glaucoma-related diagnoses were significantly more common in patients with RVOs compared with a reference group (9.8% versus 5.4%; P <.001).

Additionally, the rate of diagnosed, open-angle glaucoma was significantly greater in patients with BRVOs (4.0%) and CRVOs (4.7%) compared with a reference group (1.7%; P <.001).

Investigators noted suspicion for open-angle glaucoma was similar between patients with RVOs compared with the reference group (3.9% versus 2.9%; P = .235). Despite this, individuals with BRVOs (28.6%) and CRVOs (33.3%) were more likely to have clinical findings associated with glaucoma risk compared with the reference group (18.2%; P <.001).

Further, retinal nerve fiber layer (RNFL) imaging was more common in patients with BRVOs (89%; n = 31) compared with the reference group (54%, n = 37, P <.001). Investigators observed no significant difference was found in the rate of RNFL imaging in patients with CRVOs (68%; n = 21, P = .186).

By comparison, the rate of HVF testing in patients with CRVOs (55%, n = 17) was lower compared with the reference group (75%, n = 52, P = .040). Additionally, there was no significant difference in the rate of HVF testing in patients with BRVOs (71%, n = 25, P = .665) compared to reference.

The study, “Underdiagnosis of Risk of Glaucoma in Patients with Retinal Vein Occlusions,” was presented at ARVO 2022.