Retinal Vein Occlusion Treatment — Risk Factors & Prevention

A retinal vein occlusion constitutes a medical scenario wherein a blockage manifests in one of the retina’s blood vessels. The retina, given its high metabolic activity, necessitates abundant oxygen and energy supply. Consequently, retinal vein occlusions are classified as potential medical emergencies, posing an imminent threat of irreversible vision impairment. Continue reading to acquaint yourself with treatment strategies for this critical retinal condition that jeopardises vision and how to adapt to living with it. 

Understanding Retinal Vein Occlusion RVO

A formidable adversary to vision can be understood as a blood clot that forms in the retinal vein, leading to a decrease in blood flow and creating an unsettling sight – a mesh of abnormal blood vessels. This condition is typically called retinal vein occlusion.

Any obstruction within a retinal vein is referred to as retinal vein occlusion. When this obstruction transpires in the primary vein of the retina, it’s classified as a central retinal vein occlusion (CRVO). Conversely, when the blockage is present in one of the more diminutive derivative retinal veins, it is labelled as a branch retinal vein occlusion (BRVO).  

Causes of Retinal Vein Occlusions

Imagine a bustling highway teeming with traffic suddenly becoming obstructed by an unexpected barricade. This is the ordeal that a retina with vein occlusion suffers.

This condition manifests in two forms – central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). The first, CRVO, a severe type, involves the blockage of the central retinal vein, the main vein responsible for draining blood from the retina. BRVO, the less severe sibling, occurs when one of the smaller veins branching from the central vein is blocked.

Regardless of whether it’s CRVO or BRVO, both lead to swelling in the central part of the retina, known medically as macular edema and can be a significant cause of vision loss. As blood and fluid leak from the retinal veins into the retina, you may start to notice symptoms like blurry vision or, in severe cases, sudden blindness in one eye. It’s like a haze that slowly descends upon your world, making everything seem out of focus.

RVO is the most common cause of vision loss from retinal vascular disease.

The Symptoms of Retinal Vein Occlusion

Manifestations of retinal vein occlusion can vary and largely depend on the severity and location of the occlusion. Quite commonly, a sudden or gradual onset of vision loss or blurring is reported, which may affect part or all of the visual field.

In some instances, patients may experience the sensation of a ‘veil’ or ‘curtain’ falling over their field of vision. Furthermore, patients may notice an increase in the appearance of floaters – small dark spots or squiggly lines that move across one’s visual field.

Eye pain is more common in severe cases such as the total occlusion of the vein. It’s essential to be aware that the symptoms may solely affect one eye and, in some cases, may be asymptomatic initially. Any noticeable changes to vision should prompt an immediate consultation with an eye care professional to expedite diagnosis and treatment. 

Risk Factors and Diagnosis

Retinal vein occlusion is not an isolated condition; rather, it’s the culmination of various underlying factors. Additional risk determinants such as high blood pressure and elevated cholesterol levels can be likened to ominous silhouettes, ever-ready to precipitate complications. Individuals with diabetes are notably susceptible owing to their propensity to develop diabetic retinopathy, a distinct retinal vascular disorder.

When it comes to diagnosing retinal vein occlusion, ophthalmologists possess an arsenal of sophisticated tools and techniques. These encompass optical coherence tomography, a modality yielding intricate images of the retina, and fluorescein angiography. This dye-assisted procedure enables observation of the blood flow and the condition of retinal arteries and veins. Hence, we invite you to delve further into the diagnostic and treatment journey of retinal vein occlusion. 

The Conventional Treatment Landscape

Immediate intervention is key to preserving vision. Yet, it’s vital to note that permanent impairment and a certain level of enduring vision loss may occur, even with treatment. The optimal approach to managing a vein occlusion hinges on the blockage’s location and magnitude. Your ophthalmologist will conduct a comprehensive examination of your retina and any associated health anomalies.

Diagnostic procedures may encompass imaging modalities like optical coherence tomography, instrumental for delineating the site and severity of macular swelling, and a procedure dubbed fluorescein angiography that provides a detailed representation of the retinal blood vessels, highlighting areas of fluid leakage or retinal ischemia. 

Intravitreal Injections

First-line therapy for macular oedema precipitated by a retinal vein occlusion typically involves a treatment known as anti-VEGF injections. This modality involves the intravitreal injection (that is, directly into the eyeball) of a medication known as anti-vascular endothelial growth factor, which curtails the proliferation of aberrant new blood vessels.

Anti-VEGF injections are also utilised in managing macular oedema and accompanying macular swelling. These injections often necessitate repetition on a monthly basis for a few months at least. If needed, further injections at regular intervals may be required to uphold ‌therapeutic effects. 

Intraocular Corticosteroids

Intraocular corticosteroids present an innovative solution to reducing inflammation and swelling in the retina, particularly for those suffering from retinal vein occlusion (RVO). Administered through precise injections directly into the eye, these medications reach the affected area to provide targeted relief. Among the options, triamcinolone acetonide and dexamethasone stand out, with slow-release implants like the dexamethasone implant offering sustained, controlled treatment. For patients grappling with macular swelling following RVO, this therapy opens a new pathway to visual improvement. It’s not just an alternative but a complementary option to other advanced treatments, such as anti-VEGF injections or laser therapy, adding a personalised and comprehensive approach to patient care. 

Laser Treatment

Under certain circumstances, laser treatment is the most suitable for addressing the complications associated with retinal vein occlusion. 

Focal Laser Therapy

Focal laser therapy employs a laser instrument to seal off the blood vessels near the macula to prevent fluid leakage. In essence, the treated blood vessels undergo cauterisation, effectively closing them. 

Laser Surgery (Laser Photocoagulation or Panretinal Photocoagulation (PRP)

Laser surgery might be considered if there’s an onset of new blood vessel formation in the retina due to ischaemia. Implementing a laser to induce minuscule burns in the retina lowers its oxygen requirements and mitigates the stimulus for additional vessel growth.

Early diagnosis of retinal vein occlusion can save you from vision loss. 

Living With Retinal Vein Occlusion

Living with retinal vein occlusion requires adaptation and careful management. The objective is to maximise existing vision, mitigate further deterioration, and improve the overall quality of life. Regular follow-ups with your ophthalmologist are paramount to monitor the condition’s progression and adapt treatment plans accordingly.

Adaptations at home may include utilising ample lighting and employing visual aids such as magnifiers or high-contrast reading materials. Additionally, maintaining a healthy lifestyle can prove beneficial – this involves regular exercise, a balanced diet, and vigilance over blood pressure and cholesterol levels.

It’s also important to manage associated conditions like diabetes effectively, given their impact on retinal health. Finally, joining a support group or seeking psychological assistance can help individuals cope with the emotional challenges associated with vision loss. Living with retinal vein occlusion can be challenging, but with appropriate guidance and management, one can lead a fulfilling life.

Prevention

Prevention, as always, is a significant part of the conversation. Controlling risk factors, such as high blood pressure and cholesterol, can help prevent retinal vein occlusion. Regular eye examinations and promptly addressing any unusual symptoms can also be beneficial in early detection and treatment.

In conclusion, retinal vein occlusion presents a significant challenge to vision health, but with ongoing research and advancements in treatments, including the likes of LASIK, there is hope on the horizon. As we continue to explore the depth and breadth of these treatment options, we light the way to better vision for those in the dark due to this condition. Contact us on (03) 9070 3580 today for a consultation!

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Sources

Retinal Vein Occlusion
https://eyewiki.aao.org/Retinal_Vein_Occlusion#:~:text=Management-,General%20treatment,managed%20with%20grid%20laser%20photocoagulation.

Retinal Vein Occlusion RVO
https://my.clevelandclinic.org/health/diseases/14206-retinal-vein-occlusion-rvo

Retinal Vein Occlusion
https://medlineplus.gov/ency/article/007330.htm