What are the symptoms of retinal vein occlusion?
If you have retinal vein occlusion, you will usually notice a decrease in your vision in one eye. Some people describe having a blind spot in one eye. The condition is mostly painless unless there are complications, such as secondary raised pressure in the eye (glaucoma) caused by new blood vessels interfering with the drainage of fluid from inside the eye.
Depending on the severity and also the degree of involvement of the macula, retinal vein occlusions may cause only relatively mild visual loss. Some people who only have a small blockage of a branch retinal vein may not have any symptoms.
Retinal vein occlusion can cause very profound visual loss. This is more commonly seen in central retinal vein occlusion, which affects the whole of the retina, (including the macula where central vision is formed).
How is retinal vein occlusion diagnosed?
Retinal vein occlusion is usually diagnosed after an eye specialist (an ophthalmologist) examines the back of your eye, using an ophthalmoscope. This is a handheld instrument. They may also use a larger special light and magnifier (which you sit at and put your chin on) called a slit lamp. The retina at the back of your eye has a typical appearance in retinal vein occlusion. From the appearance of your retina, the specialist will usually know if you have a central retinal vein occlusion or a branch retinal vein occlusion.
Various other tests may be suggested, including measurement of how well you see (your visual acuity) and your visual fields (to look at how good your edge (peripheral) vision is). Some blood tests may also be suggested - for example, to check your blood sugar and cholesterol levels. Your blood pressure may also be checked.
A number of techniques can provide accurate digital images of the retina and its blood circulation. These images can help see exactly how much damage has occurred to the retina and whether (and how) it might be improved. The tests are usually done after some weeks have passed. They include:
- Retinal photographs. These show the overall image of the retina, allowing the ophthalmologist to see which areas appear to have sustained damage.
- Fluorescein angiography. This allows the ophthalmologist to look in detail at the blood vessels in the eye, and how the blood is flowing through them. A dye is injected (usually into your arm). This dye will then pass to, and move through, the blood vessels at the back of your eye. Then photographs can be taken with a camera to look at the blood flow to your retina. It is particularly helpful for identifying new vessel formation.
- Optical coherence tomography. This gives a very detailed 'cross-sectional' image of the layers of the retina, showing where there is swelling and damage, and how severe it is.
Further reading and references
Retinal Vein Occlusion (RVO) Guidelines; Royal College of Ophthalmologists (July 2015)
Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion; NICE Technology Appraisal Guidance, September 2016
Dexamethasone intravitreal implant for the treatment of macular oedema caused by retinal vein occlusion; NICE Technology Appraisal Guidance, July 2011
Anti-VEGF for Retinal Vein Occlusion: Patient Information; Moorfields Eye Hospital
Patel A, Nguyen C, Lu S; Central Retinal Vein Occlusion: A Review of Current Evidence-based Treatment Options. Middle East Afr J Ophthalmol. 2016 Jan-Mar23(1):44-8. doi: 10.4103/0974-9233.173132.
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