to 6% have evidence of more than one BRVO in the same eye (Fig. 4.6).42,45 For BRVO, the probability of developing an RVO in the fellow eye within 4 years is 7%.17 A patient who develops a macular BRVO has a 4% risk of developing a macular BRVO in the fellow eye over the subsequent 3.3 years.17 The risk of recurrence of a BRVO of any type in the same eye is low and no estimate was made.17

5.5.3 Central Retinal Vein Occlusion

In the Central Vein Occlusion Study, 3 of 725 enrolled patients had bilateral CRVO.58 In a casecontrol study of 144 CRVOs, the fellow eye had some form of RVO in 6.9%.41 The prevalence of bilateral CRVO has been reported to be 6.3– 12%.42,45 Bilaterality of CRVO seems higher than bilaterality of BRVO.42

A patient who develops a nonischemic CRVO has a 6.6% risk of developing a nonischemic CRVO in the fellow eye over the subsequent 2 years.17 A patient who develops an ischemic CRVO has a 5.6% risk of developing an ischemic CRVO in the fellow eye over the subsequent 2.8 years.17

The risk of recurrence of a nonischemic CRVO in the same eye is 0.9% over 2 years. The recurrence rate is lower and unestimated for ischemic CRVO.17

5.5.4Hemicentral Retinal Vein Occlusion

Among patients with HCRVO in one eye, 4% have been reported to have simultaneous evidence of HCRVO present in the fellow eye.42 A patient who develops a nonischemic HCRVO has a 3.5% risk of developing a nonischemic HCRVO in the fellow eye over the subsequent 2.2 years.17 A patient who develops an ischemic HCRVO has a 7.4% risk of developing an ischemic HCRVO in the fellow eye over the subsequent 0.4 years.17 The risk of recurrence of a nonischemic HCRVO in the same eye is 0.9% over 2 years. The recurrence rate is lower and unestimated for ischemic HCRVO.17

5.6 Life Expectancy

In a study of pooled RVOs, the 10-year survival after RVO was 50%, which was approximately the expected rate for an age-matched population.52 Of those who died, vascular disease was the cause in 79.4%, approximately twice the expected percentage.45 In a study from 1964, the life expectancy after BRVO was 1.5 years.41 In a population-based study, the 8-year overall survival rate was no different in patients with and without BRVO at baseline nor was the risk of dying from ischemic heart disease increased in the BRVO cohort.29

5.7Visual Impact of Retinal Vein Occlusions

The BDES examined the changes in visual acuity of a population-based cohort over a 10-year period. Incident monocular severe visual impairment defined as 20/200 or worse visual acuity occurred in 2.2% (75 of 3,402 subjects).30 Of these 75 subjects, the cause was either BRVO or CRVO in 12.1%, which was the second most important cause after macular degeneration (57.9%) and six times as frequent a cause as diabetic retinopathy (2%).34 In this population-based study, all cases of severe visual impairment from pooled RVO occurred in subjects 55 or older.30

5.8 Summary of Key Points

•RVO is the second most common retinal vascular disease after diabetic retinopathy and is the fifth most common cause of unilateral blindness.

•The best estimate for the prevalence of pooled RVO is 4.4 per 1,000 adults.

•The best estimate for the prevalence of BRVO is 3.77 per 1,000 adults.

•The best estimate for the prevalence of CRVO is 0.65 per 1,000 adults.

•The best estimate for the 10-year incidence of pooled RVO is 1.6%.

•The best estimate for the 10-year incidence of BRVO is 1.2%.

•The best estimate for the 10-year incidence of CRVO is 0.4%.

•Increasing age is a strong risk factor for all types of RVO.

•Gender is not strongly associated with any type of RVO.

•Race is associated with BRVO but not CRVO. Hispanic race is associated with the highest prevalence, and white race with the lowest.

•The risk of developing any type of RVO in the fellow eye depends on the type of the first RVO. A risk of 1% per year is a good rule of thumb. The risk of developing a second RVO in the same eye is less.

•Life expectancy after an RVO is approximately the same as in an ageand gender-matched cohort without RVO.

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