Retinal Vein Occlusion (RVO) And Macular Edema Treatment
The Retina
The retina is the light-sensing layer of cells that lines the inner wall of the back of the eye. The retina converts light into signals that are sent to the brain where they are recognized as images.
Retinal Vein Occlusions
Your retinas require a rich supply of oxygenated blood. This blood is carried to the retina from the heart through arteries, while veins carry deoxygenated blood from the retina back to the heart via the optic nerves. The arteries that transport oxygen to your retina may stiffen and thicken over the years, especially in people with diabetes, cardiovascular disease, high blood pressure and high cholesterol.
The retinal arteries and veins are close to the optic nerve and cross various locations on the retina’s surface. As arteries thicken, they can compress the retinal vein at artery-vein crossing points or in the optic nerve. This compression can be so severe that the veins become constricted and thus blood flow to the heart is reduced. The blood then backs up into the retina not unlike the water in a clogged bathtub. The pressure of blood in the veins causes swelling (called macular edema) and bleeding in the retina. There are three kinds of retinal vein occlusions:
- The most commonly seen cases are branch retinal vein occlusions, in which the blockage occurs in a smaller vein on the retina’s surface. The consequent hemorrhaging and swelling may result in diminished vision if the macula, the retina’s center, is involved.
- The second most common form of retinal vein occlusion is a central retinal vein occlusion in which the main retinal vein is blocked within the optic nerve. This is usually a more severe kind of occlusion that causes hemorrhages and swelling throughout the retina. This often leads to a more serious decrease in sight.
- Less common is hemi-retinal vein occlusion, in which the vein draining one-half of the venous circulation is occluded. Generally, this is more severe than the branch retinal vein occlusion but less so than central retinal vein occlusion.
Eyes with retinal venous occlusive disease may develop macular edema (retinal swelling), or growths of fragile, abnormal blood vessels on the retina’s surface. These growths can cause bleeding into the vitreous gel. This bleeding is typically associated with the sudden appearance of floaters or severe loss of vision. Patients with central retinal vein occlusions may also develop abnormal blood vessels on the iris. These blood vessels can cause a severe form of glaucoma known as neovascular glaucoma.
Fortunately, retinal vein occlusion is usually only present in one eye so the other eye remains unaffected.
Risk Factors For Retinal Vein Occlusions
The main risk factors include: advanced age, high blood pressure, diabetes, high cholesterol, cardiovascular disease, glaucoma, and other blood disorders. Some patients have no risk factors and a more extensive work-up to determine underlying cause may be warranted.
Reducing Your Risk
There are some effective things that a patient who is at high risk of developing retinal vein occlusion can do to avoid developing the condition. Doing frequent exercise several times a week and eating a balanced and nutritious diet can greatly reduce the chances of getting the disease. If you have a family history of high blood pressure, blood disorders, cardiovascular issues, or other health issues, taking active steps to improve your health can make a huge difference. For more information about preventative measures you can implement in your life, you can turn to an eye doctor for guidance.
Symptoms Of Retinal Vein Occlusion
People with a retinal vein occlusion may not exhibit symptoms but those who do may have a sudden onset of blurred vision in one eye. However, blurred vision is a symptom of many ocular conditions. Therefore, one will have to undergo testing to confirm that one has retinal vein occlusion.
How A Retinal Vein Occlusion Impairs Vision
Retinal vein occlusion and related diseases can result in serious long-term damage not just to your retina, but the rest of your eyes. Because the retina is affected by blood clots, you may have difficulty processing light or adjusting your eyes to light. Loss of vision can occur gradually or quickly depending on the severity of the condition. When the retina has this kind of damage, signals to the brain are not able to be processed correctly, leading to trouble identifying images since they cannot be focused properly.
- Disruption Or Loss Of Blood Flow To The Retina
There is no treatment for this aspect of retinal vein occlusion.
- Cystoid Macular Edema (CME)
Edema means “swelling,” and this occurs when blood vessels damaged from the vein occlusion are leaky, and the fluid that leaks from these vessels accumulates in the retina. The macula is the centermost part of the retina, which is responsible for much of high quality vision. Swelling in the retina results in vision loss. There are very effective treatments for macular edema caused by a retinal vein occlusion.
- Neovascularization
When the eye loses blood flow, it may respond by creating abnormal “new blood vessels” (neovascularization). Neovascular blood vessels can impact the vision by:
Vitreous Hemorrhage: A vitreous hemorrhage is bleeding into the eye. Instead of being filled with clear fluid through which one can see, the back of the eye is filled with blood, causing vision loss.
Tractional Retinal Detachment: The new blood vessels pull on the retina (create “traction”) and pull the retina off the eye wall (“retinal detachment”). The photoreceptors in detached retina cannot see and undergo damage, resulting in severe vision loss, sometimes irreversible vision loss.
Glaucoma: If the abnormal blood vessels form in in the front of the eye, they can result in glaucoma, which involves elevated eye pressure and if untreated, vision loss.
Evaluating A Retinal Vein Occlusion
There are multiple ways to evaluate a retinal vein occlusion:
- Dilated Retinal Examination
- Optical Coherence Tomography (OCT): A scan to look for swelling in the retina.
- Fluorescein Angiography: In this procedure, a dye is injected into the arm and travels through the blood to the eye. Photographs are taken of the eye which map out all the blood vessels and blood flow in the retina. This test identifies areas of blood flow loss as well as areas of new blood vessel growth (neovascularization).
- B-Scan Ultrasound: This is a painless procedure whereby an ultrasound is performed over the closed eyelid to evaluate the retinal anatomy in eyes where hemorrhage prevents visualization of retinal details through the eye exam alone.
Treatment for Retinal Vein Occlusion
There are also numerous treatment options to reduce the risk of vision loss in cases of retinal vein occlusion. For those with macular edema resulting from this condition, laser photocoagulation may help. Anti-vascular endothelial growth factors (anti-VEGF) drugs such as Lucentis, Avastin, Eylea, Eylea HD, Pavblu, Vabysmo, or Ozurdex may be injected into the vitreous gel to treat the swelling associated with this condition. These medications are injected into the eye after drops are given over 5-10 minutes to clean and numb the eye. The injection itself takes only seconds.
Steroids such as triamcinolone (Triessence) and dexamethasone (Ozurdex) may be used to reduce inflammation that contributes to leaky blood vessels causing an edema. Like many medical conditions, the treatment is done to manage the disease and reduce the risk of worsening. Thus, with intravitreal injections, patients may require life-long treatment.
Retina specialists can treat patients with the more severe kind of venous occlusive disease (neovascular glaucoma) with scatter laser to the retina and/or continued injections in hopes of stabilizing the disease process and preventing severe vision loss or blindness.
Neovascularization from a retinal vein occlusion can be treated with laser treatments, injections if there is an edema present, or surgery.
A vitreous hemorrhage from a retinal vein occlusion can be treated with observation and medical management or surgery. A vitreous hemorrhage may resolve on its own, and thus it may be monitored. After the hemorrhage resolved, laser treatment may be performed. If the hemorrhage fails to clear or other complications are noted, surgery may be necessary.
In a pars plana vitrectomy surgery, the hemorrhage is removed, the traction from the new blood vessel (neovascularization) membranes is relieved, and laser treatment is applied to allow the neovascularization to regress. An injection of anti-VEGF medication may be given prior to surgery to reduce intraoperative and postoperative complications risk.
As retinal vein occlusions are typically associated with high cholesterol, diabetes and high blood pressure, monitoring and treating these medical conditions are important in those patients with venous occlusive disease. Thus, following up with your primary care doctor is imperative.
Epiretinal Membranes Or Macular Puckers
An epiretinal membrane, also known as a macular pucker is a scar tissue that grow on top of the macula of the retina. This can significantly reduce vision and is treated through a surgical procedure.
The epiretinal membrane pulls on and wrinkles the macula, distorting the orderly arrangement of photoreceptors and other cells required for high quality, crisp vision. Vision symptoms include blur, decreased vision, and distortion (straight lines appearing bent or distorted).
Why Epiretinal Membranes Form
In most cases, epiretinal membranes form as part of the natural aging process of the eye. Epiretinal membranes may also form in eyes with a history of retinal tear, retinal detachment, inflammation (uveitis), hemorrhage, or prior surgery.
Treating Epiretinal Membranes
An epiretinal membrane can be treated through observation and surgery. Observation may be appropriate for eyes with mild epiretinal membranes with minimal impact on vision and minimal impact on retinal anatomy. Surgery may be appropriate for visually significant epiretinal membranes. A pars plana vitrectomy is an outpatient, micro-incisional surgery whereby the delicate epiretinal membrane is gently peeled off the retinal surface, allowing the retina to assume a more healthy contour (and in turn, achieve an improvement in vision) over time.
Meet With an Eye Doctor
Any kind of eye complications can be hard to live with, but if you have a serious condition like retinal vein occlusion, it is possible to mitigate the effects and consequences if you seek treatment right away. You should take this condition seriously and talk to an experienced doctor so you can begin exploring your options. Your condition may be in the early stage, so there could be multiple ways that your symptoms can be alleviated. Do not think that it is too late to save your vision if you think that you have a retinal vein occlusion and other retinal issues.
When you go to an experienced eye doctor who can help you discover suitable treatments, you can preserve the health of your eyes and reduce vision loss. Find out more about Laguna Hills retinal vein occlusion RVO and macular edema services in your area now so you can schedule a consultation.
To learn more about venous occlusive disease and how our retina specialists can help, contact our physicians at Retina Associates of Orange County.
Key Risk Factors For Blocked Retinal Veins
Vision health is paramount, and understanding the factors behind retinal vein occlusion is an important step towards maintaining good eye health. With a history of award-winning patient care (and extensive experience in clinical research), the team at Retina Associates of Orange County is ready to help you next. Take a look at some of these key risk factors, and contact us today to get started wit your treatment.
1. High Blood Pressure
High blood pressure can cause damage to the blood vessels in the retina, the layer of tissue at the back of your inner eye that processes light. Managing blood pressure is not only crucial for your overall health but also for maintaining healthy retinal veins.
2. Diabetes
Diabetes increases the risk of various eye conditions, including problems with the retinal veins. High blood sugar levels can damage the delicate vessels in the eye, leading to swelling and impaired function. Controlling your blood sugar levels through diet, exercise, and medication can help reduce this risk.
3. Smoking
Smoking is harmful to almost every organ in the body, including the eyes. The harmful substances in tobacco can constrict blood vessels, worsen blood flow, and increase the risk of damage to the retinal veins. Quitting smoking is one of the best decisions you can make for your eye health and overall well-being.
4. High Cholesterol
High levels of cholesterol can lead to the buildup of plaque in the blood vessels, including those in the eyes. This buildup can narrow the vessels and restrict blood flow, potentially leading to retinal vein occlusion and macular edema. A healthy diet and regular physical activity are effective ways to control cholesterol levels.
5. Obesity
Carrying excess weight can increase the risk of diabetes and high blood pressure, which in turn can impact the health of your retinal veins. Maintaining a healthy weight through a balanced diet and regular exercise can significantly lower the risk of eye issues.
6. Sedentary Lifestyle
A lack of physical activity can contribute to several health issues, including obesity, high blood pressure, and high cholesterol. Regular exercise helps improve blood circulation, which is beneficial for the health of the blood vessels in your eyes.
7. Use Of Certain Medications
Some types of medications, such as those that increase the risk of blood clots or affect the blood’s viscosity, can affect the health of your retinal veins. It’s important to discuss all medications you are taking with your healthcare provider to understand their impact on your eye health.
By understanding these risk factors, you can take proactive steps to protect your eye health. Regular eye examinations are important, as they allow for the early detection and treatment of problems before they progress. At Retina Associates of Orange County, we are dedicated to providing comprehensive eye care and helping you maintain your vision.
Let’s Get In Touch
If you have concerns about your eye health or any of the risk factors mentioned, please don’t hesitate to contact us. Schedule an appointment today to ensure that your eyes are as healthy as they can be. Let us help you keep a clear view of the world around you. Get in touch with us today, and see how we can assist with your retinal vein occlusion and macular edema.