Ophthalmic complications associated with COVID-19: a large US national database analysis

Abstract

Objective: To assess ophthalmic complications following COVID-19 infection and the impact of mRNA vaccination. Methods: A retrospective cohort analysis was conducted using a large US database of de-identified electronic health records (1 March 2020–30 April 2021). Patients with COVID-19 and subsequent ophthalmology evaluation were included. The vaccinated COVID-19 cohort was matched to an unvaccinated cohort (n = 73,654 each). COVID-19 and influenza patients (n = 77,809 each) were also matched. Influenza served as a historical control. Ten ophthalmic conditions were assessed post-COVID-19 infection, including retinal artery occlusion (RAO), retinal vein occlusion (RVO), retinal oedema, vitreous haemorrhage, and neuro-ophthalmic manifestations. Bonferroni correction addressed multiple comparisons. Results: Vaccinated COVID-19 patients had significantly lower odds of retinal oedema (OR 0.68; 99.5% CI, 0.54–0.85), vitreous haemorrhage (OR 0.55; 99.5% CI, 0.44–0.68), and optic neuritis (OR 0.60; 99.5% CI, 0.43–0.85) compared to unvaccinated COVID-19 patients. There were no significant differences in the incidence of RAO, RVO, or retinal haemorrhage between vaccinated and unvaccinated cohorts. COVID-19 patients exhibited higher odds of diplopia (OR 1.89; 99.5% CI, 1.53–2.32) and cranial nerve VI palsy (OR 3.19; 99.5% CI, 1.82–5.59) compared to influenza patients, while rates of optic neuritis, RAO, RVO, retinal oedema, vitreous haemorrhage, and retinal haemorrhage were similar between the groups Conclusions: Vaccination was associated with a lower incidence of retinal oedema, vitreous haemorrhage, and optic neuritis. Compared to influenza, COVID-19 was associated with diplopia and CN VI palsy, while other neuro-ophthalmic and retinal pathologies had similar risk. Further research is needed to clarify these associations and underlying mechanisms.