Treatments and Strategies to Maintain Vision
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. 1
- Panretinal Photocoagulation (PRP): A laser is used to make many small burns in the retina to reduce the growth of abnormal blood vessels. 2
- Corticosteroid medication: This medication is injected into the eye to reduce swelling in the retina. 3
- Focal Laser: A laser is used to make a few small burns in the retina to reduce abnormal blood vessel growth. 2
- Eye drops: Medications to decrease eye pressure (intraocular pressure, IOP). 4
- Prompt referral to PCP to check, monitor and treat any risk factors. 5
Swelling of the center part of the retina (macular edema) is one of the leading causes of vision loss following an RVO.6,7 Injection of vascular endothelial growth factor (VEGF) inhibitors, or anti-VEGF medications, into the eye is the most common treatment for macular edema caused by RVO.6,7 These treatments aim to decrease the fluid leakage related to macular edema and stop the growth of abnormal new blood vessels stimulated by poor retinal blood flow caused by the blood vessel blockage.6-7 Studies show that over 50% of patients with macular edema experience visual improvements with anti-VEGF injections.7 Patients with macular edema usually require periodic, repeat injections to maintain control over fluid leakage and swelling.6 Steroids injected into the eye may be used if macular edema does not resolve with anti-VEGF injections, although this treatment option has been associated with increased eye pressure and cataracts.6,7
Laser therapy is another RVO treatment, of which there are 2 types that can be used depending on the area of the retina to be treated; laser of small, specific regions (focal scatter laser photocoagulation) or of regions covering the middle or outer portions of the retina (panretinal photocoagulation, or PRP). Laser treatment aims to reduce the amount of oxygen needed by the retina, which is a stimulator for new, abnormal blood vessel growth.6 Focal laser therapy may be used to seal leaky blood vessels near the macula, and may be used in combinaiton with anti-VEGF therapy in hard-to-treat cases.6,7 PRP can be used for a complication of a RVO called neovascular glaucoma, which occurs when new blood vessels grow on the colored, ring-shaped part of the eye (iris), causing increased eye pressure.6,9
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 symptoms5
- 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 11
References
- Heier JS, Campochiaro PA, Yau 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.
- University of Michigan Health. Laser Photocoagulation for Diabetic Retinopathy. 2020. https://www.uofmhealth.org/health-library/tf4075.
- 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.
- Hayreh SS, Zimmerman MB, Beri M, Podhajsky P. Intraocular pressure abnormalities associated with central and hemicentral retinal vein occlusion. Ophthalmology. 2004;111:133-141.
- Flaxel CJ, Adelman RA, Bailey ST, et al. Retinal vein occlusion Preferred Practice Pattern®. Ophthalmology. 2020;127:P288-P320.
- American Society of Retina Specialists (ASRS). Central retinal vein occlusion. 2020. https://www.asrs.org/patients/retinal-diseases/22/central-retinal-vein-occlusion.
- ASRS. Branch retinal vein occlusion. 2020. https://www.asrs.org/patients/retinal-diseases/24/branch-retinal-vein-occlusion.
- ASRS. Glossary. https://www.asrs.org/patients/retinal-diseases/10/glossary/#Glaucoma.
- Huang A. Preserving vision in neovascular glaucoma. Rev Ophthalmol. 2015. https://www.reviewofophthalmology.com/article/preserving-vision-in-neovascular-glaucoma.
- The Angiogenesis Foundation. Science of RVO. Anti-VEGF therapy. 2020.
- Kolar P. Risk factors for central and retinal branch retinal vein occlusion: A meta-analysis of published clinical data. J Ophthamol. 2014;2014:724780.
