Mortality risk associated with ocular ischemic syndrome in New Orleans

Mortality risk associated with ocular ischemic syndrome in New Orleans | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mortality risk associated with ocular ischemic syndrome in New Orleans Judith Fan, Nouran Sabaugh, Wei Fang, David Hinkle This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4590935/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To explore the relationship between ocular ischemic syndrome (OIS) and mortality in a New Orleans patient population. Methods Thirty-two patients diagnosed with OIS at University Medical Center (UMC) in New Orleans, Louisiana between 2011 and 2022 were compared to a historical population with respect to prevalence of systemic diseases and the mortality rate Results The five-year mortality rate was 21% and the ten-year mortality rate was 38%. Associated disease and risk factors included hypertension (91%), diabetes mellitus (62%), ischemic heart disease (31%), cerebrovascular accident (22%), peripheral vascular disease (22%), and a history of smoking (66%). Conclusion A diagnosis of OIS is associated with high rates of ocular and systemic diseases. High morbidity and mortality rates persist despite improvements in medical and surgical care. ocular ischemic syndrome venous stasis retinopathy carotid stenosis mortality Figures Figure 1 Introduction Ocular ischemic syndrome (OIS), formerly known as venous stasis retinopathy, is a rare condition present in approximately 5% of patients with carotid stenosis [ 1 ]. Temporal arteritis, chronic ophthalmic artery and central retinal artery occlusions, carotid artery dissection, and Eisenmenger’s syndrome may also lead to ocular ischemic syndrome. The estimated incidence of ocular ischemic syndrome is 7–8 cases per million patients per year and 20% of cases are bilateral. Complications occur when the common or internal carotid artery is > 90% stenosed or occluded, usually ipsilaterally, causing a reduction in perfusion pressure of the central retinal artery [ 2 , 3 ]. A major cause of this disease is atherosclerosis [ 4 ]. Cerebrovascular accidents or cardiovascular diseases often precede a diagnosis of OIS, leading to increased risk for morbidity and mortality [ 5 ]. Patients with OIS are more commonly male, have higher incidences of cardiovascular disease, and have higher mortality rates [ 2 ]. Symptoms of OIS include gradual visual impairment, sudden vision loss, and intermittent, dull, aching orbital pain. Signs of ocular ischemic syndrome include rubeosis iridis in two-thirds of cases, ciliary injection with elevated intraocular pressure or hypotony due to poor ciliary body perfusion and decreased aqueous production. Aqueous cells and flare may be present, and cataracts can develop in later stages. Retinal artery narrowing and retinal venous dilation are common. Mid-peripheral, dot and blot intraretinal hemorrhages are present in approximately 80% of affected eyes. Neovascularization of the optic disc and retina can occur, rarely leading to traction retinal detachment. Cotton wool spots, spontaneous retinal arterial pulsations, and ischemic optic neuropathy rarely may develop. Sivalingam et al. studied 52 patients with OIS and reported the prevalence of systemic diseases (hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular accident, and peripheral vascular disease). The 5-year mortality rate was 40% [ 6 ]. The purpose of this study was to determine the prevalence of systemic diseases, smoking history, and the mortality rate in patients diagnosed with OIS in New Orleans compared to the Sivalingam study. Materials and methods The Tulane University and University Medical Center (UMC) Institutional Review Boards granted this study exempt status and all patient identifiers were removed from the dataset. This study was conducted in adherence to the Declaration of Helsinki and United States federal and state laws. Using the Slicer Dicer function of the electronic health record system (EPIC, Verona WI), thirty-two patients at UMC in New Orleans, Louisiana were identified with a diagnosis of OIS who received an ophthalmologic examination between 2011 and 2022. The patient medical history was reviewed for the prevalence of atherosclerotic diseases, such as hypertension and diabetes mellitus. Systemic diseases and risk factors including ischemic heart disease, cerebrovascular accident, peripheral vascular disease, and smoking history were recorded. Patients were assigned a systemic risk factor if the systemic condition was treated with medication. Mortality data was obtained from the UMC electronic health record, the Social Security Death Index, and public obituaries. Life tables were used to estimate the five- and ten-year mortality rates. The prevalence of systemic diseases and survival rates were compared to the populations from the Sivalingam study. Results The average age of patients with OIS at presentation was 64.6 years old (range 46–93 years). The male to female ratio was 62–38%. The demographic breakdown included 63% Blacks, 31% non- Hispanic whites, and 6% Hispanics. Associated Systemic Diseases Ninety-one percent of patients had hypertension, 62% had diabetes mellitus, 31% had ischemic heart disease, 22% had cerebrovascular accidents, 12% had peripheral vascular disease, and 66% had a history of smoking. The rates of systemic diseases were compared to those in the Sivalingam study (Table 1 ). Table 1 Prevalence of systemic disease associated with OIS patients compared to the control (Sivalingam) population. Systemic Disease OIS Control Hypertension 91% 73% Diabetes Mellitus 62% 56% Ischemic Heart Disease 31% 48% Cerebrovascular Accident 22% 27% Peripheral Vascular Disease 12% 19% History of smoking 66% NA Mortality Rate Life table analysis was used to estimate the mortality rates in New Orleans patients with a diagnosis of OIS. The five-year mortality rate was 21% and the ten-year mortality rate was 38%. Race The population included 6 non-Hispanic white males, 13 Black males, 1 Hispanic male, 4 non-Hispanic white females, 7 Black females, and one Hispanic female. Of the 32 patients, 8 died. The number of deaths in each group were 2 out of 6 non-Hispanic white males (33%), 2 out of 13 Black males (15%), 2 out 4 non-Hispanic white females (50%), and 2 out of 7 Black females (29%). Discussion The average age at presentation for patients diagnosed with OIS in this study was 64.6 years, very similar to the average age of 64.3 years reported in the Sivalingam study. Compared to the Sivalingham population, the prevalence of hypertension and diabetes mellitus was higher, whereas the prevalence of ischemic heart disease, cerebrovascular accident, and peripheral vascular disease were lower. The five-year mortality rate was 21% and the ten-year mortality rate was 38% compared to the Sivialingam study which reported a five-year mortality rate of 40% in patients with OIS and 11% in age and gender matched controls from the Framingham study. The difference in five-year mortality rates may due to these improvements in medical and surgical management during the 25 years since the Sivalingam study, differences in smoking history, or differences in the methods used to record mortality. The premature heart disease mortality rate decreased 70% from 1968 until 2017 in the United States.[ 7 ]. Between the years 1980 and 2000, it is estimated that half the decline in U.S. deaths from coronary heart disease was attributable to reductions in major risk factors and half to the application of evidence-based medical and surgical therapies.[ 8 ] This study demonstrates that New Orleans patients with OIS have high rates of atherosclerotic risk factors, such as diabetes and hypertension. Compared to the Sivalingam study, OIS patients in New Orleans have a higher prevalence of diabetes and hypertension and a lower prevalence of ischemic heart disease, cerebrovascular disease, and peripheral vascular disease despite improvements in the ability to diagnose acute and chronic vascular ischemic conditions. The New Orleans population contains a higher proportion of Black individuals (63% compared to the Sivalingam group 25%), followed by non-Hispanic whites at 31% and Hispanics at 6%. The percentage of Hispanic patients was not reported in the Sivalingam study. In addition, two thirds of the patients had a history of smoking, an atherosclerotic risk factor not reported in the Sivalingam study. Weaknesses of this study include the methods used to determine death which may underestimate the mortality rate and does not allow determination of the cause of death in all cases. Assigning the presence of a systemic disease to patients treated with systemic medications was consistent with the method in the Sivalingam study but may underestimate the true prevalence of systemic conditions. The analysis does not include social determinants of health which are known to contribute to health care disparities and excess mortality. The sample size is too small to determine the relative risk of mortality conferred by each risk factor. The results may not be generalizable to other populations and are not intended to guide management of individual patients. In conclusion, patients diagnosed with OIS should be closely monitored by an ophthalmologist and primary care physician in order to diagnose and treat associated ocular and systemic diseases given the high morbidity and mortality rates which persist despite improvements in medical care. Declarations Funding: This research was supported in whole or in part by the Louisiana Board of Regents Endowed Chairs for Eminent Scholars Program. Author Contribution JF, NS, and DH wrote the main manuscript textWF performed the statistical analysis and generated the figuresAll authors reviewed the manuscript References Kearns TP, Hollenhorst RW. Venous-stasis retinopathy of occlusive disease of the carotid artery. Mayo Clin Proc. 1963;38:304–312. Terelak-Borys B, Skonieczna K, Grabska-Liberek I. Ocular ischemic syndrome - a systematic review. Med Sci Monit. 2012;18:138–144. Mendrinos E, Machinis T, Pournaras C. Ocular Ischemic Syndrome. Surv Ophthalmol 2010;55:2–34. Sood G, Siddik A. Ocular Ischemic Syndrome. StatPearls 2022. Kang H, Choi J, Koh H, Slikel L. Significant changes of the choroid in patients with ocular ischemic syndrome and symptomatic carotid artery stenosis. PLoS ONE. 2019;14:xxx. Sivalingam A, Brown GC, Magargal LE, Menduke H. The ocular ischemic syndrome. II. Mortality and systemic morbidity. Int Ophthalmol. 1989;133:187–91. US Centers for Disease Control and Prevention (CDC). Leading causes of death , Atlanta, GA: CDC; 2019. Accessed at https://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf on 6/2/24. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell S. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356:2388–98. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4590935","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":321708630,"identity":"bfef13aa-b0d7-47c1-9204-431c8c814f6f","order_by":0,"name":"Judith Fan","email":"","orcid":"","institution":"Tulane University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Judith","middleName":"","lastName":"Fan","suffix":""},{"id":321708631,"identity":"eb4c2c2f-bf06-47af-a60c-ec91d079d780","order_by":1,"name":"Nouran Sabaugh","email":"","orcid":"","institution":"University of Alabama","correspondingAuthor":false,"prefix":"","firstName":"Nouran","middleName":"","lastName":"Sabaugh","suffix":""},{"id":321708632,"identity":"7878330f-191c-4c2a-90d8-c3498b264695","order_by":2,"name":"Wei Fang","email":"","orcid":"","institution":"West Virginia University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Fang","suffix":""},{"id":321708633,"identity":"c1d4734b-cd2a-4195-8be1-c1a51ef0a7b4","order_by":3,"name":"David Hinkle","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYDCCG4wNjA0FDHIMDMwNEJEDRGkxYDDmYWAkWgsDA0hLYg/RWvhuN7c9nGFgk75fIrHxc0EFgxzfjQT8WiTvHGw33GCQltsjkdgsPeMMg7EkIS0GNxLbJB8YHAZpaZDmbWNI3ECklv/pPEBbfvP+Y6gnTssGgwMJQC1t0rwNDAkGBP0C0jLDINmw58zDNmueYxKGM888wK+F70b6M8meCjt59vbkw7d5amzk+Y4TsAUdSJCmfBSMglEwCkYBdgAAfQVJHGVZghkAAAAASUVORK5CYII=","orcid":"","institution":"Tulane University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"","lastName":"Hinkle","suffix":""}],"badges":[],"createdAt":"2024-06-16 21:59:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4590935/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4590935/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60344317,"identity":"511ba553-3915-4f67-9293-a69d7fd46b78","added_by":"auto","created_at":"2024-07-15 19:22:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44845,"visible":true,"origin":"","legend":"\u003cp\u003eGraphic representation of survival rates in patients with OIS compared to the control (Sivalingam) population.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4590935/v1/d00254f7c6a39f7ed6b8c656.png"},{"id":61244837,"identity":"2ecf7637-2c99-407d-92eb-7d760f23d863","added_by":"auto","created_at":"2024-07-28 06:59:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":260664,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4590935/v1/80b2bb4f-1025-4e73-ba66-2afe113bf4ed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mortality risk associated with ocular ischemic syndrome in New Orleans","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOcular ischemic syndrome (OIS), formerly known as venous stasis retinopathy, is a rare condition present in approximately 5% of patients with carotid stenosis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Temporal arteritis, chronic ophthalmic artery and central retinal artery occlusions, carotid artery dissection, and Eisenmenger\u0026rsquo;s syndrome may also lead to ocular ischemic syndrome. The estimated incidence of ocular ischemic syndrome is 7\u0026ndash;8 cases per million patients per year and 20% of cases are bilateral. Complications occur when the common or internal carotid artery is \u0026gt;\u0026thinsp;90% stenosed or occluded, usually ipsilaterally, causing a reduction in perfusion pressure of the central retinal artery [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A major cause of this disease is atherosclerosis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Cerebrovascular accidents or cardiovascular diseases often precede a diagnosis of OIS, leading to increased risk for morbidity and mortality [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Patients with OIS are more commonly male, have higher incidences of cardiovascular disease, and have higher mortality rates [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSymptoms of OIS include gradual visual impairment, sudden vision loss, and intermittent, dull, aching orbital pain. Signs of ocular ischemic syndrome include rubeosis iridis in two-thirds of cases, ciliary injection with elevated intraocular pressure or hypotony due to poor ciliary body perfusion and decreased aqueous production. Aqueous cells and flare may be present, and cataracts can develop in later stages. Retinal artery narrowing and retinal venous dilation are common. Mid-peripheral, dot and blot intraretinal hemorrhages are present in approximately 80% of affected eyes. Neovascularization of the optic disc and retina can occur, rarely leading to traction retinal detachment. Cotton wool spots, spontaneous retinal arterial pulsations, and ischemic optic neuropathy rarely may develop.\u003c/p\u003e \u003cp\u003eSivalingam et al. studied 52 patients with OIS and reported the prevalence of systemic diseases (hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular accident, and peripheral vascular disease). The 5-year mortality rate was 40% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The purpose of this study was to determine the prevalence of systemic diseases, smoking history, and the mortality rate in patients diagnosed with OIS in New Orleans compared to the Sivalingam study.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe Tulane University and University Medical Center (UMC) Institutional Review Boards granted this study exempt status and all patient identifiers were removed from the dataset. This study was conducted in adherence to the Declaration of Helsinki and United States federal and state laws. Using the Slicer Dicer function of the electronic health record system (EPIC, Verona WI), thirty-two patients at UMC in New Orleans, Louisiana were identified with a diagnosis of OIS who received an ophthalmologic examination between 2011 and 2022. The patient medical history was reviewed for the prevalence of atherosclerotic diseases, such as hypertension and diabetes mellitus. Systemic diseases and risk factors including ischemic heart disease, cerebrovascular accident, peripheral vascular disease, and smoking history were recorded.\u003c/p\u003e \u003cp\u003ePatients were assigned a systemic risk factor if the systemic condition was treated with medication. Mortality data was obtained from the UMC electronic health record, the Social Security Death Index, and public obituaries. Life tables were used to estimate the five- and ten-year mortality rates. The prevalence of systemic diseases and survival rates were compared to the populations from the Sivalingam study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe average age of patients with OIS at presentation was 64.6 years old (range 46\u0026ndash;93 years). The male to female ratio was 62\u0026ndash;38%. The demographic breakdown included 63% Blacks, 31% non- Hispanic whites, and 6% Hispanics.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAssociated Systemic Diseases\u003c/h2\u003e \u003cp\u003eNinety-one percent of patients had hypertension, 62% had diabetes mellitus, 31% had ischemic heart disease, 22% had cerebrovascular accidents, 12% had peripheral vascular disease, and 66% had a history of smoking. The rates of systemic diseases were compared to those in the Sivalingam study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of systemic disease associated with OIS patients compared to the control (Sivalingam) population.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic Disease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOIS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIschemic Heart Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular Accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral Vascular Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMortality Rate\u003c/h2\u003e \u003cp\u003eLife table analysis was used to estimate the mortality rates in New Orleans patients with a diagnosis of OIS. The five-year mortality rate was 21% and the ten-year mortality rate was 38%.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eRace\u003c/h2\u003e \u003cp\u003eThe population included 6 non-Hispanic white males, 13 Black males, 1 Hispanic male, 4 non-Hispanic white females, 7 Black females, and one Hispanic female. Of the 32 patients, 8 died. The number of deaths in each group were 2 out of 6 non-Hispanic white males (33%), 2 out of 13 Black males (15%), 2 out 4 non-Hispanic white females (50%), and 2 out of 7 Black females (29%).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe average age at presentation for patients diagnosed with OIS in this study was 64.6 years, very similar to the average age of 64.3 years reported in the Sivalingam study. Compared to the Sivalingham population, the prevalence of hypertension and diabetes mellitus was higher, whereas the prevalence of ischemic heart disease, cerebrovascular accident, and peripheral vascular disease were lower.\u003c/p\u003e \u003cp\u003eThe five-year mortality rate was 21% and the ten-year mortality rate was 38% compared to the Sivialingam study which reported a five-year mortality rate of 40% in patients with OIS and 11% in age and gender matched controls from the Framingham study. The difference in five-year mortality rates may due to these improvements in medical and surgical management during the 25 years since the Sivalingam study, differences in smoking history, or differences in the methods used to record mortality. The premature heart disease mortality rate decreased 70% from 1968 until 2017 in the United States.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Between the years 1980 and 2000, it is estimated that half the decline in U.S. deaths from coronary heart disease was attributable to reductions in major risk factors and half to the application of evidence-based medical and surgical therapies.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis study demonstrates that New Orleans patients with OIS have high rates of atherosclerotic risk factors, such as diabetes and hypertension. Compared to the Sivalingam study, OIS patients in New Orleans have a higher prevalence of diabetes and hypertension and a lower prevalence of ischemic heart disease, cerebrovascular disease, and peripheral vascular disease despite improvements in the ability to diagnose acute and chronic vascular ischemic conditions. The New Orleans population contains a higher proportion of Black individuals (63% compared to the Sivalingam group 25%), followed by non-Hispanic whites at 31% and Hispanics at 6%. The percentage of Hispanic patients was not reported in the Sivalingam study. In addition, two thirds of the patients had a history of smoking, an atherosclerotic risk factor not reported in the Sivalingam study.\u003c/p\u003e \u003cp\u003eWeaknesses of this study include the methods used to determine death which may underestimate the mortality rate and does not allow determination of the cause of death in all cases. Assigning the presence of a systemic disease to patients treated with systemic medications was consistent with the method in the Sivalingam study but may underestimate the true prevalence of systemic conditions. The analysis does not include social determinants of health which are known to contribute to health care disparities and excess mortality. The sample size is too small to determine the relative risk of mortality conferred by each risk factor. The results may not be generalizable to other populations and are not intended to guide management of individual patients.\u003c/p\u003e \u003cp\u003eIn conclusion, patients diagnosed with OIS should be closely monitored by an ophthalmologist and primary care physician in order to diagnose and treat associated ocular and systemic diseases given the high morbidity and mortality rates which persist despite improvements in medical care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003e This research was supported in whole or in part by the Louisiana Board of Regents Endowed Chairs for Eminent Scholars Program.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJF, NS, and DH wrote the main manuscript textWF performed the statistical analysis and generated the figuresAll authors reviewed the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKearns TP, Hollenhorst RW. Venous-stasis retinopathy of occlusive disease of the carotid artery. Mayo Clin Proc. 1963;38:304\u0026ndash;312.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTerelak-Borys B, Skonieczna K, Grabska-Liberek I. Ocular ischemic syndrome - a systematic review. Med Sci Monit. 2012;18:138\u0026ndash;144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMendrinos E, Machinis T, Pournaras C. Ocular Ischemic Syndrome. Surv Ophthalmol 2010;55:2\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSood G, Siddik A. Ocular Ischemic Syndrome. \u003cem\u003eStatPearls\u003c/em\u003e 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKang H, Choi J, Koh H, Slikel L. Significant changes of the choroid in patients with ocular ischemic syndrome and symptomatic carotid artery stenosis. PLoS ONE. 2019;14:xxx.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSivalingam A, Brown GC, Magargal LE, Menduke H. The ocular ischemic syndrome. II. Mortality and systemic morbidity. Int Ophthalmol. 1989;133:187\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUS Centers for Disease Control and Prevention (CDC). \u003cem\u003eLeading causes of death\u003c/em\u003e, Atlanta, GA: CDC; 2019. Accessed at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e on 6/2/24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFord ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell S. Explaining the decrease in U.S. deaths from coronary disease, 1980\u0026ndash;2000. N Engl J Med. 2007;356:2388\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ocular ischemic syndrome, venous stasis retinopathy, carotid stenosis, mortality","lastPublishedDoi":"10.21203/rs.3.rs-4590935/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4590935/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo explore the relationship between ocular ischemic syndrome (OIS) and mortality in a New Orleans patient population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThirty-two patients diagnosed with OIS at University Medical Center (UMC) in New Orleans, Louisiana between 2011 and 2022 were compared to a historical population with respect to prevalence of systemic diseases and the mortality rate\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe five-year mortality rate was 21% and the ten-year mortality rate was 38%. Associated disease and risk factors included hypertension (91%), diabetes mellitus (62%), ischemic heart disease (31%), cerebrovascular accident (22%), peripheral vascular disease (22%), and a history of smoking (66%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eA diagnosis of OIS is associated with high rates of ocular and systemic diseases. High morbidity and mortality rates persist despite improvements in medical and surgical care.\u003c/p\u003e","manuscriptTitle":"Mortality risk associated with ocular ischemic syndrome in New Orleans","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-15 19:21:53","doi":"10.21203/rs.3.rs-4590935/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4dda9554-3db7-4262-bdd7-57e867fded3d","owner":[],"postedDate":"July 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-28T06:51:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-15 19:21:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4590935","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4590935","identity":"rs-4590935","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}