Risk of Retinal Vascular Occlusion After COVID-19 Vaccination

Case reports have described patients with variable vision loss, blind spots and blurred vision within days of COVID-19 vaccination. The association between the vaccination and retinal artery occlusion and retinal vein occlusion was unclear, though. Were these cases coincidences.

Ian Dorney and colleagues from Case Western Reserve University and the Cleveland Clinic Cole Eye Institute conducted a study to investigate how often patients diagnosed with new-onset retinal vascular occlusion after the mRNA COVID-19 vaccine compared with cases after influenza and tetanus-diphtheria-pertussis (Tdap) vaccination. They used data from the COVID-19 Research Network, an electronic health record database of more than 103 million patients in nine countries.

Their findings, reported in JAMA Ophthalmology, suggest that retinal vascular occlusion diagnosed acutely after mRNA COVID-19 vaccination is extremely rare, with rates similar to those of the influenza and Tdap vaccinations. Of 3,108,829 patients who received the COVID-19 vaccine, 104 had a new diagnosis of retinal vascular occlusion within 21 days of the first vaccination, equating to an incidence of 3.4 individuals per 100,000. The relative risk was not significantly different from that of influenza or Tdap vaccinations but was greater than after the second dose of the COVID-19 vaccination.

Vaccine hesitancy and fear of adverse effects may have played a part in the results. The lower risk of retinal vascular occlusion after the second dose of the mRNA COVID-19 vaccination compared with the first dose could be explained by, among other things, a reluctance to receive the second dose based on symptoms occurring after the first dose, the researchers say. The number of patients who were documented to have received a second dose was less than half of those who received a first dose. Moreover, influenza and Tdap vaccination queries were performed during 2018 to 2019 to eliminate the possibility of COVID-19 vaccination within the study group. Any differences in willingness to present to a healthcare professional with possible retinal vascular occlusion might be a consequence of the pandemic, the researchers note, when “substantial changes in ophthalmology visits” were observed.

The findings underscore the importance of substantiating information about the frequency of post-vaccination retinal vascular occlusions, a serious condition that can cause blindness. Dorney and colleagues also points up the importance of vaccination: COVID-19 infection itself may carry a higher risk for new retinal vascular occlusion, the researchers say. Their post hoc analysis comparing the risk for new retinal vascular occlusion after infection versus after vaccination showed a 4.25 times higher risk.