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Dedania, Vaidehi S., MD*; Zacks, David N., MD, PhD*; Pan, Wei, MS; VanderBeek, Brian L., MD, MPH, MSCE‡,§,¶

doi: 10.1097/IAE.0000000000001869
Original Study

Purpose: To determine whether testosterone supplementation is associated with retinal artery occlusion (RAO) or retinal vein occlusion (RVO).

Methods: Retrospective matched cohort study using data from a large national U.S. insurance database. The testosterone cohort consisted of all male patients who filled a prescription for testosterone from 2000 to 2013. Five controls were matched on age (±3 years), sex, race, and similar time in plan (±3 months) for every exposed patient. Exclusion occurred for <2 years in the plan, <1 eye care visit, medications known to affect androgen levels, and systemic diseases associated with occlusions or increased testosterone. Cox proportional hazard regression assessed the hazard of a new diagnosis of RAO or RVO while controlling for age, race, diabetes mellitus, and hypertension.

Results: A total of 35,784 incident testosterone users were compared with 178,860 matched controls. Ninety-three (0.3%) RAOs and 50 (0.1%) RVOs were found in the testosterone cohort and contrasted with 316 (0.2%) RAOs and 232 (0.1%) RVOs in the control group. After multivariate analysis, testosterone supplementation significantly increased the hazard of RAO (hazard ratio: 1.43, 95% confidence interval: 1.12–1.81, P = 0.004), but not of RVO (hazard ratio: 1.03, 95% confidence interval: 0.74–1.42, P = 0.86).

Conclusion: Although the incidence of RAO and RVO is low in users of testosterone, supplementation therapy is associated with an increased hazard of RAO, but apparently not of RVO.

This is a study that evaluated for an association between testosterone supplementation and retinal vascular occlusions, which found a significantly increased hazard for developing retinal arterial occlusion with exogenous testosterone use.

*Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan;

Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;

Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;

§Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and

Leonard Davis Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Reprint requests: Brian L. VanderBeek, MD, MPH, MSCE, Scheie Eye Institute, University of Pennsylvania, 51 North 39th Street, Philadelphia, PA 19104; e-mail:

National Institutes of Health K23 Award (1K23EY025729-01) and University of Pennsylvania Core Grant for Vision Research (2P30EYEY001583). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding was provided by Research to Prevent Blindness and the Paul and Evanina Mackall Foundation. Funding from each of the above sources was received in the form of block research grants to the Scheie Eye Institute. None of the organizations had any role in the design or conduction of the study.

Portions of these data will be presented at International Conference on Pharmacoepidemiology Annual Meeting, Montreal, Canada, August 28, 2017.

None of the authors has any conflicting interests to disclose.

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© 2018 by Ophthalmic Communications Society, Inc.