What is the treatment for retinal vein occlusion?
It isn't currently possible to remove the blockage in the tiny retinal vein. Treatment is concentrated on:
- Minimising the damaging effects of the blockage.
- Reducing the risk of a further retinal vein occlusion in the same, or the other, eye.
- Treating any complications.
Minimising the damaging effects
The damage to your retina in retinal vein occlusion is caused by the damaged blood vessels, which then leak fluid. A number of different treatments are used with the aim of reducing the swelling, so that the retina can recover. The earlier this is done, the better the chance of some recovery:
- Anti-vascular endothelial growth factor (anti-VEGF). These medicines, which include ranibizumab, bevacizumab and aflibercept, stop the abnormal blood vessels growing then leaking and bleeding under the retina. They are effective in preventing further central vision loss in 9 times out of 10. Only patients with active leaking of blood and fluid can benefit from these medicines. The medicine is injected into your eye with a fine needle. Local anaesthetic drops are applied to numb your eye and minimise discomfort.
- Steroids. These are also given by injection into the eye. The injections often need to be repeated because their effect wears off as your body 'clears' them from the eye.
- Laser treatment. This is sometimes used in branch retinal vein occlusions and it may be helpful to central vision.
Reducing the risk of a further retinal vein occlusion
It is very important to detect and treat any underlying risk factors for the condition, as you have already 'proved' you are at risk of the condition. The aim is both to reduce the risk of you developing the same condition in the other eye and also to prevent a further vein occlusion in the eye which is already affected. This includes:
- Treatment of high blood pressure. See separate leaflet called High Blood Pressure (Hypertension) for more details.
- Treatment of raised cholesterol levels. See separate leaflet called Cholesterol for more details.
- Good control of diabetes. See separate leaflet called Type 2 Diabetes for more details.
- Giving up smoking if you are a smoker. See separate leaflet called Tips to Help you Stop Smoking for more details.
- Treatment for blood clotting disorders or rare blood problems.
- Diagnosis and treatment of raised pressure in the eye (glaucoma).
Can retinal vein occlusion be prevented?
The same things that can help to reduce your risk of cardiovascular disease may also possibly reduce your risk of retinal vein occlusion. For example:
- Treating high blood pressure if you have high blood pressure.
- Good control of diabetes if you have diabetes.
- Stopping smoking if you are a smoker.
- Reducing high cholesterol levels if they are raised.
- Aiming to be physically active and do regular exercise, if possible.
- Losing weight if you are overweight.
Will my vision return?
Following a retinal vein occlusion you are likely to be left with some visual loss. The extent of the visual loss can vary greatly, depending on the severity of the blockage, the exact site of the vein occlusion, and the degree of complications you experienced. Early diagnosis and treatment may make a difference to the eventual level of visual loss.
Some partial recovery of vision may occur after branch retinal vein occlusion, and visual loss in this condition usually affects only part of the vision of one eye. However, severe central retinal vein occlusions can cause permanent visual loss, even if treated very early.
Retinal vein occlusion will happen again in about 1 in 6 people (either in the same eye or in the other eye) over the five years following on from it.
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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