Retinal vascular occlusion — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 50 of 2020

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting retinal vascular occlusion or death from retinal vascular occlusion with the circumstances of a person's relevant service:

1. (1)
   having smoked at least ten pack-years of tobacco products before the clinical onset of retinal vascular occlusion, and where smoking has permanently ceased, the clinical onset of retinal vascular occlusion has occurred within ten years of cessation;

   Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

2. (2)
   having hypertension before the clinical onset of retinal vascular occlusion;
3. (3)
   having diabetes mellitus before the clinical onset of retinal vascular occlusion;
4. (4)
   being obese for at least five years within the 15 years before the clinical onset of retinal vascular occlusion;

   Note: being obese is defined in the Schedule 1 - Dictionary.

5. (5)
   having dyslipidaemia before the clinical onset of retinal vascular occlusion;

   Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.

6. (6)
   having hyperhomocysteinaemia before the clinical onset of retinal vascular occlusion;
7. (7)
   having an arteritis from the specified list of systemic arteritides, at the time of the clinical onset of retinal vascular occlusion;

   Note: specified list of systemic arteritides is defined in the Schedule 1 - Dictionary.

8. (8)
   having retinal vasculitis at the time of the clinical onset of retinal vascular occlusion;

   Note: retinal vasculitis is defined in the Schedule 1 - Dictionary.

9. (9)
   having a non-inflammatory vasculopathy of the cerebral or retinal vessels from the specified list of vasculopathies at the time of the clinical onset of retinal vascular occlusion;

   Note: specified list of vasculopathies is defined in the Schedule 1 - Dictionary.

10. (10)
    having a disorder that is associated with a hypercoagulable state or hyperviscosity at the time of the clinical onset of retinal vascular occlusion;

    Note: disorder that is associated with a hypercoagulable state or hyperviscosity is defined in the Schedule 1 - Dictionary.

11. (11)
    having: (a) a benign or malignant neoplasm; or (b) a non-neoplastic mass lesion; which compresses or infiltrates the retinal vessels of the affected eye at the time of the clinical onset of retinal vascular occlusion;

    Note: Examples of a benign or malignant neoplasm include astrocytoma, optic nerve meningioma, leukaemia and lymphoma.

    Note: Examples of a non-neoplastic mass lesion include haematoma, sarcoidosis, neurofibromatosis and exophthalmos.

12. (12)
    having a vascular abnormality of the retinal vessels of the affected eye at the time of the clinical onset of retinal vascular occlusion;

    Note: Examples of a vascular abnormality include arterio-venous malformation and prepapillary vascular loop.

13. (13)
    having migraine at the time of the clinical onset of retinal vascular occlusion;
14. (14)
    having infection with human immunodeficiency virus before the clinical onset of retinal vascular occlusion;
15. (15)
    having an ocular or orbital infection involving the affected eye within the 30 days before the clinical onset of retinal vascular occlusion; (a) cat scratch disease; (b) herpes zoster ophthalmicus; (c) ocular tuberculosis; and (d) orbital abscess or cellulitis;

    Note: Examples of an ocular or orbital infection include:.

    Note: This excludes isolated conjunctivitis or blepharitis of the affected eye.

16. (16)
    having direct external pressure to the eyeball of the affected eye for a continuous period of at least ten minutes, within the 24 hours before the clinical onset of retinal vascular occlusion; (a) surgery in the prone position; (b) surgery involving the use of a device that compresses the eyes; and (c) positioning that places direct mechanical pressure on the eye;

    Note: Examples of causes of direct external pressure to the eyeball include:.

17. (17)
    having a blunt or penetrating injury involving the affected eye or the blood vessels supplying or draining the affected eye, including surgery or a therapeutic procedure, within the seven days before the clinical onset of retinal vascular occlusion; (a) blunt trauma to the orbit; (b) eyeball contusion; and (c) intraocular foreign body. (a) cataract surgery; (b) filler injection to the forehead, or the glabellar, nasal or nasolabial fold regions; (c) intraocular or retrobulbar anaesthesia; (d) intravitreal bevacizumab injection; and (e) sclerotherapy of facial veins;

    Note: In the case of prolonged unconsciousness associated with trauma, the seven day period is taken to commence upon regaining consciousness.

    Note: Examples of blunt or penetrating injury include:.

    Note: Examples of surgery or a therapeutic procedure include:.

18. (18)
    taking a drug from the specified list of drugs within the 72 hours before the clinical onset of retinal vascular occlusion;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

19. (19)
    taking a combined oral contraceptive pill for a continuous period of at least 21 days within the one year before the clinical onset of retinal vascular occlusion;
20. (20)
    experiencing an acute hypotensive episode within the 24 hours before the clinical onset of retinal vascular occlusion;

    Note: acute hypotensive episode is defined in the Schedule 1 - Dictionary.

21. (21)
    for retinal venous occlusion only: (a) having open-angle glaucoma, angle-closure glaucoma or ocular hypertension, at the time of the clinical onset of retinal vascular occlusion; (b) having chronic renal failure at the time of the clinical onset of retinal vascular occlusion; (c) being severely dehydrated at the time of the clinical onset of retinal vascular occlusion; or (d) having obstructive sleep apnoea at the time of the clinical onset of retinal vascular occlusion;

    Note: ocular hypertension is defined in the Schedule 1 - Dictionary.

    Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

    Note: being severely dehydrated is defined in the Schedule 1 - Dictionary.

22. (22)
    for retinal arterial occlusion only: (a) having carotid artery disease at the time of the clinical onset of retinal vascular occlusion; (b) having a cardiac disease with the potential to give rise to a retinal embolus at the time of the clinical onset of retinal vascular occlusion; (a) acute myocardial infarction; (b) atrial fibrillation; and (c) mitral or aortic valve disease. (c) having a non-cardiac potential source of retinal embolus at the time of the clinical onset of retinal vascular occlusion; or (a) aortic arch atherosclerosis; (b) atherosclerotic central retinal artery; (c) decompression sickness; (d) deep vein thrombosis in the presence of a potential route of paradoxical embolism; (e) pulmonary barotrauma; and (f) severe bone trauma. (d) undergoing a procedure to the heart or the carotid artery, or an intravascular procedure involving the vessels of the head or neck, within the seven days before the clinical onset of retinal vascular occlusion; (a) cardiac surgery or cardiac catheterisation; (b) coronary angiography; and (c) coronary artery bypass grafting. (a) carotid angioplasty; (b) carotid endarterectomy; and (c) carotid stenting. (a) cosmetic vein sclerotherapy to the orbital adnexa, face, nose or sinuses; (b) transcatheter thyroid artery embolisation; and (c) transfemoral cerebral angiography;

    Note: Examples of a cardiac disease with the potential to give rise to a retinal embolus include:.

    Note: Examples of a non-cardiac potential source of retinal embolus include:.

    Note: Examples of a procedure to the heart include:.

    Note: Examples of a procedure to the carotid artery include:.

    Note: Examples of an intravascular procedure involving the vessels of the head or neck include:.

23. (23)
    having smoked at least ten pack-years of tobacco products before the clinical worsening of retinal vascular occlusion, and where smoking has permanently ceased, the clinical worsening of retinal vascular occlusion has occurred within ten years of cessation;

    Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

24. (24)
    having hypertension before the clinical worsening of retinal vascular occlusion;
25. (25)
    having diabetes mellitus before the clinical worsening of retinal vascular occlusion;
26. (26)
    being obese for at least five years within the 15 years before the clinical worsening of retinal vascular occlusion;

    Note: being obese is defined in the Schedule 1 - Dictionary.

27. (27)
    having dyslipidaemia before the clinical worsening of retinal vascular occlusion;

    Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.

28. (28)
    having hyperhomocysteinaemia before the clinical worsening of retinal vascular occlusion;
29. (29)
    having an arteritis from the specified list of systemic arteritides, at the time of the clinical worsening of retinal vascular occlusion;

    Note: specified list of systemic arteritides is defined in the Schedule 1 - Dictionary.

30. (30)
    having retinal vasculitis at the time of the clinical worsening of retinal vascular occlusion;

    Note: retinal vasculitis is defined in the Schedule 1 - Dictionary.

31. (31)
    having a non-inflammatory vasculopathy of the cerebral or retinal vessels from the specified list of vasculopathies at the time of the clinical worsening of retinal vascular occlusion;

    Note: specified list of vasculopathies is defined in the Schedule 1 - Dictionary.

32. (32)
    having a disorder that is associated with a hypercoagulable state or hyperviscosity at the time of the clinical worsening of retinal vascular occlusion;

    Note: disorder that is associated with a hypercoagulable state or hyperviscosity is defined in the Schedule 1 - Dictionary.

33. (33)
    having: (a) a benign or malignant neoplasm; or (b) a non-neoplastic mass lesion; which compresses or infiltrates the retinal vessels of the affected eye at the time of the clinical worsening of retinal vascular occlusion;

    Note: Examples of a benign or malignant neoplasm include astrocytoma, optic nerve meningioma, leukaemia and lymphoma.

    Note: Examples of a non-neoplastic mass lesion include haematoma, sarcoidosis, neurofibromatosis and exophthalmos.

34. (34)
    having a vascular abnormality of the retinal vessels of the affected eye at the time of the clinical worsening of retinal vascular occlusion;

    Note: Examples of a vascular abnormality include arterio-venous malformation and prepapillary vascular loop.

35. (35)
    having migraine at the time of the clinical worsening of retinal vascular occlusion;
36. (36)
    having infection with human immunodeficiency virus before the clinical worsening of retinal vascular occlusion;
37. (37)
    having an ocular or orbital infection involving the affected eye within the 30 days before the clinical worsening of retinal vascular occlusion; (a) cat scratch disease; (b) herpes zoster ophthalmicus; (c) ocular tuberculosis; and (d) orbital abscess or cellulitis;

    Note: Examples of an ocular or orbital infection include:.

    Note: This excludes isolated conjunctivitis or blepharitis of the affected eye.

38. (38)
    having direct external pressure to the eyeball of the affected eye for a continuous period of at least ten minutes, within the 24 hours before the clinical worsening of retinal vascular occlusion; (a) surgery in the prone position; (b) surgery involving the use of a device that compresses the eyes; and (c) positioning that places direct mechanical pressure on the eye;

    Note: Examples of causes of direct external pressure to the eyeball include:.

39. (39)
    having a blunt or penetrating injury involving the affected eye or the blood vessels supplying or draining the affected eye, including surgery or a therapeutic procedure, within the seven days before the clinical worsening of retinal vascular occlusion; (a) blunt trauma to the orbit; (b) eyeball contusion; and (c) intraocular foreign body. (a) cataract surgery; (b) filler injection to the forehead, or the glabellar, nasal or nasolabial fold regions; (c) intraocular or retrobulbar anaesthesia; (d) intravitreal bevacizumab injection; and (e) sclerotherapy of facial veins;

    Note: In the case of prolonged unconsciousness associated with trauma, the seven day period is taken to commence upon regaining consciousness.

    Note: Examples of blunt or penetrating injury include:.

    Note: Examples of surgery or a therapeutic procedure include:.

40. (40)
    taking a drug from the specified list of drugs within the 72 hours before the clinical worsening of retinal vascular occlusion;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

41. (41)
    taking a combined oral contraceptive pill for a continuous period of at least 21 days within the one year before the clinical worsening of retinal vascular occlusion;
42. (42)
    experiencing an acute hypotensive episode within the 24 hours before the clinical worsening of retinal vascular occlusion;

    Note: acute hypotensive episode is defined in the Schedule 1 - Dictionary.

43. (43)
    for retinal venous occlusion only: (a) having open-angle glaucoma, angle-closure glaucoma or ocular hypertension, at the time of the clinical worsening of retinal vascular occlusion; (b) having chronic renal failure at the time of the clinical worsening of retinal vascular occlusion; (c) being severely dehydrated at the time of the clinical worsening of retinal vascular occlusion; or (d) having obstructive sleep apnoea at the time of the clinical worsening of retinal vascular occlusion;

    Note: ocular hypertension is defined in the Schedule 1 - Dictionary.

    Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

    Note: being severely dehydrated is defined in the Schedule 1 - Dictionary.

44. (44)
    for retinal arterial occlusion only: (a) having carotid artery disease at the time of the clinical worsening of retinal vascular occlusion; (b) having a cardiac disease with the potential to give rise to a retinal embolus at the time of the clinical worsening of retinal vascular occlusion; (a) acute myocardial infarction; (b) atrial fibrillation; and (c) mitral or aortic valve disease. (c) having a non-cardiac potential source of retinal embolus at the time of the clinical worsening of retinal vascular occlusion; or (a) aortic arch atherosclerosis; (b) atherosclerotic central retinal artery; (c) decompression sickness; (d) deep vein thrombosis in the presence of a potential route of paradoxical embolism; (e) pulmonary barotrauma; and (f) severe bone trauma. (d) undergoing a procedure to the heart or the carotid artery, or an intravascular procedure involving the vessels of the head or neck, within the seven days before the clinical worsening of retinal vascular occlusion; (a) cardiac surgery or cardiac catheterisation; (b) coronary angiography; and (c) coronary artery bypass grafting. (a) carotid angioplasty; (b) carotid endarterectomy; and (c) carotid stenting. (a) cosmetic vein sclerotherapy to the orbital adnexa, face, nose or sinuses; (b) transcatheter thyroid artery embolisation; and (c) transfemoral cerebral angiography;

    Note: Examples of a cardiac disease with the potential to give rise to a retinal embolus include:.

    Note: Examples of a non-cardiac potential source of retinal embolus include:.

    Note: Examples of a procedure to the heart include:.

    Note: Examples of a procedure to the carotid artery include:.

    Note: Examples of an intravascular procedure involving the vessels of the head or neck include:.

45. (45)
    inability to obtain appropriate clinical management for retinal vascular occlusion;

Aggravation-only factors: the factors in subsections 9(23) to 9(45) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.