Retinal Vein Occlusion – KK Eye Hospitals

Cutting edge treatments that save vision

RVO is a partial or total blockage in a vein that drains blood from your retina. A blockage in a retinal vein prevents blood from leaving your retina. This can lead to complications, including raised pressure in your eye and swelling. These issues need prompt treatment to prevent or minimise vision loss.

Types of blockage

1. Central Retinal Vein Occlusion (CRVO), or blockage of the main retinal vein.
2. Branch Retinal Vein Occlusion (BRVO), or blockage of one of the smaller branch veins. This type is more common.

There is currently no safe way to unblock the vein. However, treatment can manage complications and protect your vision.

Vitreoretinal surgeons tailor treatment to your individual needs. You may need multiple treatments ranging from injections to surgery to manage your condition.

Symptoms of retinal vein occlusion typically affect one eye and include:

Blurry vision or vision loss

This may start suddenly or develop gradually

Floaters

Dark spots or lines in your field of vision

Pain or pressure in your eye

This is typically in more severe cases

You may not have any symptoms until complications arise. Some people don’t realise there’s a problem until their provider finds the issue during a routine eye exam.

Risk factors

Being over age 40 is a major risk factor. RVO usually affects people in their 50s or 60s. However, this condition can also affect people younger than the age of 40.

Having certain medical conditions can also raise your risk. These include:

Atherosclerosis
Diabetes
Glaucoma
High blood pressure
Prior history of retinal vein occlusion in one eye raises your risk of developing the condition in your other eye

Complications

Cystoid macular edema – This is swelling in the centre of your retina (macula). It can cause blurry vision or loss of vision.
Neovascularisation of the eye – Abnormal blood vessels can form in different parts of your eye, typically your iris (rubeosis iridis). This happens in about 1 in 4 people with RVO. Abnormal blood vessels can commonly form in your retina, too.
Bleeding in your eye (vitreous haemorrhage) – This is when blood leaks into your vitreous humour, the gel-like substance that fills your eyeball. It results from the formation of abnormal blood vessels, which are prone to leaking.
Neovascular glaucoma – Abnormal blood vessels in your eye can cause pain and a dangerous increase in pressure inside your eye.
Retinal detachment – Abnormal blood vessels in your retina may cause your retina to pull away from the tissues that support it.

People with RVO have a higher risk of cardiovascular diseases, including stroke, compared to people without RVO. This may be due to shared underlying risk factors like high blood pressure and atherosclerosis.

Diagnosis and tests

Eye care specialists diagnose RVO through an eye exam and retinal imaging tests. They also coordinate care with your primary care physician (PCP) to discover the cause of blood flow problems.

Eye exam

Your eye care specialist will dilate your pupils so they can see into the back of each eye. They’ll use a slit lamp microscope and a head-mounted ophthalmoscope to shine a light into your eye. They’ll closely examine the inside of your eye to look for complications and signs of vision loss.

Tests to diagnose retinal vein occlusion

Fundus photography – This form of retinal imaging shows the presence of abnormal new blood vessels and the amount of bleeding inside your eye.
Optical Coherence Tomography (OCT)—This form of high-resolution imaging shows the presence of macular edema. It measures the thickness of the retina and provides precise numbers that help guide the treatment of your condition over time.
Fluorescein angiography – For this test, dye is injected into a vein in your arm. The dye travels to the blood vessels in your retina and makes them stand out in imaging. Your retina surgeon may use this form of imaging to show the extent of a blockage in your retinal vein. This test also shows how much of your retina isn’t receiving adequate blood flow.

Management and treatment

There’s currently no way to reverse or cure the blockage in your retinal vein. But eye care specialists can prevent or treat the complications of retinal vein occlusion with:

Anti-VEGF injections
Steroid injections
Panretinal photocoagulation (PRP)
Vitrectomy surgery
Medications to manage risk factors

The goals of treatment are to:

Improve your vision or prevent it from getting worse.
Identify and treat complications that can harm your vision and eye health.
Manage risk factors to prevent future problems.

Your provider will combine treatment options as necessary and explain the timing for each.

Anti-VEGF injections

This is a first-line (first-choice) treatment for people with macular edema. VEGF stands for vascular endothelial growth factor. This is a protein that spurs new blood vessel growth (angiogenesis). Too much VEGF can lead to the formation of abnormal blood vessels that can leak and cause swelling.

Anti-VEGF injections interrupt the production of VEGF in your eye to reduce swelling. Your surgeon gives you eye drops to numb your eye and reduce pain before injecting the medication into the gel-like substance (vitreous humour) that fills your eyeball. You may need injections at regular intervals for one to two years, depending on your condition.

Specific medications you may receive in these injections include:

Aflibercept (Eyelea)
Bevacizumab (Avastin)
Ranibizumab (Accentrix)

Steroid injections

Injections of steroid medication into your eye can also help reduce swelling. However, in some people, steroid injections cause elevated eye pressure and cataracts. So, they’re often a second-line treatment when Anti-VEGF injections aren’t adequate.

Panretinal photocoagulation (PRP)

This laser surgery creates small burns in areas of your retina that lack blood flow. Doing so decreases the number of proteins (VEGF) that promote the formation of abnormal blood vessels. Reducing VEGF helps prevent neovascularization and related bleeding in your eye. It also helps keep your intraocular pressure stable.

Vitrectomy surgery

Posterior Pars Plana Vitrectomy (PPV) is a surgery that helps people with retinal vein occlusion who have:

Severe bleeding in their eye (vitreous haemorrhage).
Bleeding that lasts more than four weeks.
Bleeding that keeps coming back.
Retinal detachment.

Surgery removes vitreous humour from your eye and repairs damage to your retina.

Medications to manage risk factors

Many people with retinal vein occlusion have underlying conditions like high blood pressure, diabetes or high cholesterol. These conditions can raise your risk of blood vessel problems. Your eye care specialist will work together with your primary care physician (PCP) to tailor treatment to your needs.