Energy drinks linked to young RVO

Jonathan Brugger, a vitreoretinal surgeon in Charleston, South Carolina, said at the American Academy of Ophthalmology’s October 26, 2024 meeting that he is collecting cases of young adults who developed central or branch retinal vein occlusions after heavy energy-drink use. In an interview published by Ophthalmology Times, Brugger said the patients were men and women presenting “for no apparent cause” and had negative workups before doctors focused on beverage habits. He said several reported consuming two, three or four energy drinks a day before the episode. Brugger did not present the cases as proof that the drinks caused the eye events. ### What exactly did the doctor say he was seeing? Jonathan Brugger said the cohort involves “young adults, both male and female” with central retinal vein occlusions, known as CRVO, or branch retinal vein occlusions, known as BRVO, without an obvious explanation after standard evaluation. In the Ophthalmology Times transcript, he said the team then reviewed patient histories and found heavy energy-drink consumption. (ophthalmologytimes.com) The October 26, 2024 interview identified examples including Red Bull and Monster, though Brugger did not name a specific product as responsible. He said the patients were being treated and that the cohort is being expanded to include retinal hemorrhages and micro- and macroaneurysms. ### How unusual is retinal vein occlusion in younger adults? (ophthalmologytimes.com) The American Academy of Ophthalmology’s 2024 Preferred Practice Pattern says retinal vein occlusions are a thrombotic blockage of the retinal venous system and that prognosis varies by location and ischemia. The guideline says central retinal vein occlusions and hemi-central retinal vein occlusions generally have a worse course than branch retinal vein occlusion, with higher risk of neovascular complications. (ophthalmologytimes.com) A June 2024 ARVO abstract on CRVO after intense exercise underscored that younger cases are uncommon enough to draw separate study. That series included eight patients younger than 50, with a mean age of 33.8 years, and said hypercoagulable workups were unremarkable in all cases. The authors said dehydration and relative hyperviscosity after intense exercise “may contribute” in some patients. (aao.org) ### Does this report show that energy drinks cause the blockage? The October 2024 presentation described an association, not a proven causal link. Brugger said the patients had negative workups and heavy energy-drink exposure, but the interview did not cite a controlled study, incidence rate or mechanism proving the beverages caused the retinal vein occlusions. (iovs.arvojournals.org) AAO guidance and published retinal vein occlusion summaries list established contributors such as vascular compression, glaucoma, hypertension and other systemic or ocular factors. In younger patients, the literature also discusses less common predispositions including thrombophilia, autoimmune disease, pregnancy, oral contraceptive use and dehydration-related states. (ophthalmologytimes.com) ### Why are doctors asking about caffeine and drink habits? Brugger said the cases changed how he takes history in younger patients whose standard evaluations do not point to a cause. In the interview, he said doctors should investigate whether patients are consuming energy drinks when they present with unexplained retinal vascular events. (aao.org) The same interview said the review may extend beyond younger patients. Brugger said his group is also considering whether older patients with macroaneurysms or retinal hemorrhaging should be asked about energy-drink use, because older adults may also consume the products. ### What treatment do patients get once an occlusion is found? (ophthalmologytimes.com) The AAO’s February 2025 retinal vein occlusion guidance says first-line treatment for macular edema associated with CRVO or BRVO is intravitreal anti-vascular endothelial growth factor therapy. The guidance also says corticosteroids can work but carry risks including glaucoma and cataract formation, while laser photocoagulation is sometimes used in BRVO. (ophthalmologytimes.com) The 2024 ARVO exercise-related CRVO series reported that 75% of patients received anti-VEGF treatment. That abstract said mean visual acuity improved modestly at six months, with outcomes better in non-ischemic than ischemic cases. ### What comes next from this case series? Brugger said his group is still gathering patients and medical records. In the October 26, 2024 interview, he said the next step is to analyze outcomes, presentations and behavioral changes aimed at lowering blood pressure, which he described as a key factor in vein occlusions. (aao.org) (ophthalmologytimes.com) (iovs.arvojournals.org)