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about Retinal Vein Occlusion

Meet Donna and learn about her experience with treatment as an RVO patient

What is Retinal Vein Occlusion (RVO)?

Retinal vein occlusion (RVO) is a partial or complete blockage of a vein in the retina, a light-sensitive tissue in the back of the eye. A blockage of the central vein is called a central retinal vein occlusion (CRVO) and blockage of smaller vein is called a branch retinal vein occlusion (BRVO). 1 RVO can cause vision loss by swelling of the macula - the central area of the retina (macular edema), bleeding in the retina, or abnormal blood vessel growth (neovascularization) in the eye. 2

BRVO is 6-7 times more common than CRVO. 3 People who have RVO have an increased risk of other cardiovascular diseases (stroke, heart attack, heart failure and peripheral artery disease) and death. 4 It is important to see your primary care provider (PCP) soon after RVO diagnosis. 1

Some people will have no symptoms at all with RVO. 1

Understanding CRVO 5

Understanding BRVO 6

Symptoms may include: 5, 6

Blurred vision

Sudden loss of vision

Blind spot in vision

Pain or pressure in the eye

Distorted vision

(Example: a straight line appearing bent)

Increased floaters

(Example: spots or webs floating inside the eyes)

Know your risk factors for RVO (CRVO and BRVO)

Age: People age 40 and older are at higher risk but RVO is most common between the ages 60 and 80. 7

Prior RVO: A person with a CRVO in one eye has a 1% chance per year of developing a CRVO in the other eye.8 A person with a BRVO in one eye has a ~ 12% chance of developing an RVO in the other eye over 4 years. 9

High blood pressure: Know your blood pressure numbers and goals for good control. 10

Diabetes: Know your hemoglobin A1c (HbA1c) level, a measure of your average blood sugar level over 3 months. It is recommended that HbA1c be 7.0% or lower for most patients. 11

Arteriosclerosis (hardening of the arteries): Your PCP will make recommendations on how to prevent further arteriosclerosis. 7

High cholesterol: Know your cholesterol levels and goals for good control.

Additional Risk Factors for CRVO:

Sleep apnea: Your PCP will evaluate you for signs and symptoms and recommend testing if they suspect sleep apnea. 12

To help control your high blood pressure, diabetes, arteriosclerosis and high cholesterol you should take your medications as directed, get 2.5 hours of moderate (heart pumping) exercise per week, eat a healthy diet and maintain a healthy weight. 13

Glaucoma: Your eye care provider will recommend treatment if needed. Treatment is often an eye drop used daily. 14

If you are 40 years and under and develop RVO, your risk factors may be different. Visiting your PCP to have additional testing is important. 15

It is important for your PCP to know you have an RVO. Your PCP will check, monitor and treat high blood pressure, diabetes, arteriosclerosis, high cholesterol and sleep apnea.

3 myths about Retinal Vein Occlusion

MYTH

I have a spot in my vision but I can still see okay, so I don’t need to get it checked out.

FACT

Retinal vein occlusions can have no symptoms, very subtle symptoms or major symptoms. It is important to speak with your eye doctor about any change in your vision. 1

MYTH

Retinal vein occlusions have nothing to do with my general health.

FACT

About 48% of RVOs are caused by high blood pressure, 20% of RVOs are caused by high cholesterol and 5% are caused by diabetes. 16

MYTH

I’m younger than 50 years old and don’t have any of the risk factors listed. I couldn’t have an RVO.

FACT

58% of people with CRVO under age 50 have non-traditional risk factors such as blood clotting disorders and autoimmune disorders.15

Maintaining healthy eyes and vision

Get a dilated eye exam at age 40 if you have never had one before, even if you don’t have any symptoms 1

Contact your eye care provider if you experience vision changes

Know how often your eye doctor wants to see you for follow up and stick to the schedule

Take all your medications as directed

Quit smoking 7

Commonly used treatments

Anti-VEGF medication: The medication is injected into the eye to decrease swelling in the macula and prevent abnormal blood vessel growth. 17

Panretinal Photocoagulation (PRP): A laser is used to make many small burns in the retina to reduce the growth of abnormal blood vessels. 18

Corticosteroid medication: This medication is injected into the eye to reduce swelling in the retina. 19

Focal Laser: A laser is used to make a few small burns in the retina to reduce abnormal blood vessel growth. 18

Eye drops: Medications to decrease eye pressure (intraocular pressure, IOP). 20

Prompt referral to PCP to check, monitor and treat any risk factors. 1

Treating CRVO

Treating BRVO 22

Barriers to eye care

Fear of treatment: Speak with your doctor before your appointment if fear may prevent you from going to the appointment. Pain with eye injection is mild for the majority of people.23 There are medications to control pain when treatment with PRP laser is needed. 24

Cost of care: Ask your eye doctor what programs are available to reduce your cost.

Meet Donna, who explains her experience with anti-VEGF injections for RVO

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References:

1 Flaxel CJ, Adelman RA, Bailey ST, et al. Retinal Vein Occlusion Preferred Practice Pattern®. Ophthalmology. 2020;127:P288-P320.

2 Buehl W, Sacu S, Schmidt-Erfurth U. Retinal Vein Occlusions. Dev Ophthalmol. 2010;46:54-72.

3 Zhou JQ, Xu L, Wang S, et al. The 10-year incidence and risk factors of retinal vein occlusion: The Beijing eye study. Ophthalmology. 2013;120:803-808.

4 Wu CY, Riangwiwat T, Limpruttidham N, et al. Association of retinal vein occlusion with cardiovascular events and mortality: A systematic review and meta-analysis. Retina. 2019;39:1635-1645.

5 Gregori NZ. What is central retinal vein occlusion (CRVO)? American Academy of Ophthalmology. Reviewed September 8, 2020. Accessed December 28, 2020. Available from: https://www.aao.org/eye-health/diseases/what-is-central-retinal-vein-occlusion

6 Gregori NZ. What is Branch Retinal Vein Occlusion (BRVO)? American Academy of Ophthalmology. 2020. Accessed December 28, 2020. Available from: https://www.aao.org/eye-health/diseases/what-is-branch-retinal-vein-occlusion

7 Kolar P. Risk factors for central and retinal branch retinal vein occlusion: A meta-analysis of published clinical data. J Ophthalmology. 2014;2014:724780.

8 Natural history and clinical management of central retinal vein occlusion. The Central Vein Occlusion Group. Arch Ophthalmol. 1997;115:486-491.

9 Hayreh SS, Zimmerman MB, Podhajsky P. Incidence of various types of retinal vein occlusion and their recurrence and demographic characteristics. Am J Ophthalmol. 1994;117:429-441.

10 Hayreh SS, Zimmerman MB, McCarthy MJ, Podhajsky P. Systemic diseases associated with various types of retinal vein occlusion. Am J Ophthalmol. 2001;131:61-77.

11 Ferris FL 3rd, Nathan DM. Preventing diabetic retinopathy progression. Ophthalmology. 2016;123:1840-1842.

12 Chou KT, Huang CC, Tsai DC, et al. Sleep Apnea and risk of retinal vein occlusion: A nationwide population-based study of Taiwanese. Am J Ophthalmol. 2012;154:200-205.

13 Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.

14 The Eye Disease Case-Control Study Group. Risk factors for central retinal vein occlusion. Arch Ophthalmol. 1996;114:545-554.

15 Rothman AL, Thomas AS, Khan K, Fekrat S. Central retinal vein occlusion in young individuals: A comparison of risk factors and clinical outcomes. Retina. 2019;39:1917-1924.

16 O’Mahoney PRA, Wong DT, Ray JG. Retinal vein occlusion and traditional risk factors for atherosclerosis. Arch Ophthalmol. 2008;126:692-699.

17 Heier JS, Campochiaro PA, Yao L, et al. Ranibizumab for macular edema due to retinal vein occlusions: long term follow up in the HORIZON trial. Ophthalmology. 2012;119:802-809.

18 University of Michigan. Laser Photocoagulation for Diabetic Retinopathy. Accessed January 13,2021. https://www.uofmhealth.org/health-library/tf4075

19 Scott IU, Ip MS, Vanveldhuisen PC, et al. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion: the standard care vs corticosteroid for retinal vein occlusion (SCORE) study report 6. Arch Ophthalmol. 2009;127:1115-1128.

20 Hayreh SS, Zimmerman MB, Beri M, Podhajsky P. Intraocular pressure abnormalities associated with central and hemicentral retinal vein occlusion. Ophthalmology. 2004;111:133-141.

21 American Academy of Ophthalmology. Central Retinal Vein Occlusion (CRVO) diagnosis and treatment.Reviewed by Gregori NZ, September 8, 2020. Accessed December 28, 2020. Available from: https://www.aao.org/eye-health/diseases/central-retinal-vein-occlusion-diagnosis

22 American Academy of Ophthalmology. Branch Retinal Vein Occlusion (BRVO) treatment. Reviewed by Gregory NZ, September 8, 2020. Accessed December 28, 2020. Available from: https://www.aao.org/eye-health/diseases/branch-retinal-vein-occlusion-treatment

23 Shiroma, H.F., Takaschima, A.K.K., Farah, M.E. et al. Patient pain during intravitreal injections under topical anesthesia: A systematic review. Int J Retina Vitreous. 2017;3:23.

24 Wu Wc, Hsu KH, Chen TL, et al. Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial. Eye. 2006;20:712-719.