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Retinal Vein Occlusion

What is Retinal Vein Occlusion (RVO)?

Retinal vein occlusion (RVO) is a common eye condition where one of the veins in the retina becomes blocked, leading to decreased blood flow and potential damage to the retina.

 

 

What are the symptoms of Retinal Vein Occlusion?

The main symptom of RVO is sudden blurry vision or vision loss in one eye. Sometimes, the vision loss can be severe.Other symptoms may include seeing floaters (tiny specks that move across your vision) or a curtain obscuring your vision.

 

 

Are there different types of Retinal Vein Occlusion?

Yes, there are two main types:

  • Central retinal vein occlusion (CRVO): This occurs when the main vein of the retina is blocked.

  • Branch retinal vein occlusion (BRVO): This occurs when one of the smaller branches of the retinal vein is blocked.

 

 

What Causes Retinal Vein Occlusion?

Retinal vein occlusion can occur due to various factors, including:

  • Aging: Risk increases with age

  • High blood pressure (hypertension)

  • Diabetes

  • Blood clotting disorders

  • Smoking

  • High cholesterol levels

  • Glaucoma 

 

 

How is a Retinal Vein Occlusion Diagnosed?

An Ophthalmologist or Optometrist can diagnose a retinal vein occlusion through a comprehensive eye exam, which may include:

  • Vision testing

  • Dilated eye exam

  • Special Retinal scans, such as optical coherence tomography (OCT) or fluorescein angiography

 

 

What Are the Treatment Options for Retinal Vein Occlusion?

Treatment for retinal vein occlusion aims to manage symptoms and prevent complications. Options may include:

  • Observation: In some cases, no treatment may be necessary and close monitoring may be all that is needed 

  • Eye injections: If fluid and swelling occurs in the retina, a special type of medication may need to be injected into the eye to dry it up. See below for a more detailed explanation about eye injections

  • Laser therapy: Laser therapy may be used in certain cases to prevent abnormal blood vessel growth that can cause bleeds and vision loss

  • Surgery: Occasionally, surgery may be necessary to remove blood from the eye 

Cystoid macular oedema in retinal vein occlusion

Scan of the retina demonstrating the swelling and fluid from retinal vein occlusion.

 

The photo below demonstrates the significant improvement of the retina after eye injections 

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What is the long-term outlook for someone with a Retinal Vein Occlusion?

The long-term outlook for people with Retinal Vein Occlusion varies depending on the severity of the blockage and any complications that develop. Early diagnosis and treatment are important to minimize vision loss, hence the need for regular checks and eye scans. 

 

 

Tell me more about the eye injections. 

In order to dry up a swollen retina, a medication class called anti-VEGF, needs to be injected into the eye. These medications work by inactivating molecules that cause abnormal growth of blood vessels in your eye.  

 

There is also another class of medications, which is very effective in the right subset of patients - a dissolvable steroid implant (Ozurdex).

 

 

Can you give a description of the injection procedure?

Injecting medicine into the eyeball sounds scary, but rest assured it is a short, painless procedure and over before you know it. This is usually done in my procedure room, with the steps as follows

  • You are asked to lie down on the treatment bed where local anaesthetic drops are instilled into your eye to numb it 

  • This is followed by a local anaesthetic injection (which is painless), to numb it further 

  • Once the eye is completely numb, your eye is then sterilised with antiseptic 

  • I get my patients to look down towards their nose, and within 2 seconds the injection is done, with most patients not even realising it’s over! 

  • The eye is then washed with some sterile saline solution 

  • No pad or eye shield is required after 

 

 

What happens after the injection? 

  • You can go home directly after, but it is important to have someone drive you home 

  • Patients are advised to obsessive about keeping the eye clean for the next 2 days. This means 

    • Avoiding any dusty or dirty places where there is potential for debris to get into the eye

    • Avoid any non-sterile water getting into the eye for 2 days. Showering is fine but do not get any water into the eye.

    • Avoid rubbing your eye   

    • No swimming for 1 week  

 

 

How often will I need injections? Is one injection enough?  

  • Unfortunately, swelling of the retina from a Retinal Vein Occlusion requires a course of at least 7-8 injections to maintain or to improve your eyesight. 

  • The frequency of injections will vary depending on how well your eye responds to the injections. If your eye responds favourably, we will be able to increase the intervals between injections gradually – from every 4 weeks initially up to every 4 months (that means only 4 injections per year).  

  • If your eye remains well at 4 months, we can then have a discussion about considering a trial of no injections

  • A typical injection schedule looks like this

Typical intravitreal injection schedule for retinal vein occlusion

  • If there is worsening of the swelling of your retina, the frequency of intervals will need to be reduced (this is all tailored to your eye and will be discussed in more detail with you)  

 

 

Are there any risks with eye injections? 

  • As with any procedure, eye injections despite being straightforward, are not risk-free. This is why I spend time discussing the pros and cons of treatment vs no treatment with my patients. 

  • Common but minor side-effects include feelings of irritation or grittiness of the eye, red eyes or some superficial bleeding on the surface of the eye. These are all transient and go away after a few days to weeks. Over-the-counter lubricating drops can help with these symptoms. 

  • The worst-case scenario is getting an infection in the eye after an injection (termed endophthalmitis). This is an extremely rare occurrence, with past data showing that the chance of this happening is about 1 in 2000-3000. Although rare, an infection in the eye can be devastating and potentially cause blindness, hence my constant nagging to patients to be obsessive about hand hygiene and eye cleanliness after each injection!   

  • Please click here to read a more in-depth discussion about risks of surgery/procedures.

  • There are other uncommon risks associated with injections that I will discuss with you in detail + give you an information sheet to take home.  

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