Retinal vein occlusion - diagnosis and treatment
We fight vision loss
Ophthalmologist for retinal vein occlusion Diagnosis and therapy for patients
Retinal vein occlusion is also called the „stroke of the eye“. Learn here, how it comes about, who might be affected, and how we can help our patients.
What is retinal vein occlusion?
- Retinal vein occlusion is the case of a blockage of the veinous drainage, usually because of a blood clot (thrombus) which is often located at the narrowest part of the vein, keeping the blood from flowing back.
- Another reason may be arteriosclerosis, where the occlusion results from modified arteries. Again, the blood is hardly or not at all able to flow.
- The compromised blood supply causes retinal bleeding, edema, vessel proliferation, or, worst of all, retina detachment.
- An accumulation of liquids at the point of sharpest vision (yellow spot / macula) is called macular edema.
How does a retinal vein occlusion come about and who is affected?
Occurrance of retinal vein occlusion
During sleep or when in lying position, arterial blood pressure falls while the pressure in the central veins of the eyes rises. Those affected experience a substantial visual limitation early in the morning that possibly gets better in the course of the day. Consequences for visual impairment in the future depend on the occlusion location and the size of the affected area.
Who is affected by retinal vein occlusion?
People with retinal vein occlusion tend to be in the age group of 60 – 70 years. 5 – 12 percent of all patients with a single retinal vein occlusion have the other eye affected, too, within the next 5 years.
What types of retinal vein occlusion are there?
Retinal vein occlusion can be divided into two types:
Central vein occlusion
This occlusion forms at the blind spot area – a physiological bottleneck inside the retina. This is where the optic nerve, the central vein, and the central eye artery enter (and leave).
Branch retinal vein occlusion
An occlusion at the area where veins and arteries cross inside the eye. Branch retinal vein occlusions are 5 times more common than central vein occlusions.
Vision loss because of retinal vein occlusion
Compromised blood supply
People affected see everything blurred due to retinal vein occlusion. Possibly, a macular edema develops, too. Then, patients suffer from what is described as a grey curtain in the field of vision.
Retina bleeding, edema, vessel proliferation, and retina detachment are all caused by an inappropriate blood supply.
An accumulation of liquids at the point of sharpest vision (yellow spot / macula) is called macular edema.
Risks and origins of retinal vein occlusion
How does a retinal vein occlusion happen?
At this point, we don’t know the reasons of this disease. Retinal vein occlusion is also called the „stroke of the eye“.
A connection to organic illnesses, such as cardiovascular diseases or blood count changes, is assumed. Local risk factors are various eye diseases or eye traumas.
Known risk factors for retinal vein occlusion:
- High blood pressure
- Coronary heart disease
- Blood count changes (blood agglutination)
- Eye diseases: Glaucoma, plaque on the optic disc
Diagnosis and therapy of retinal vein occlusion
How we diagnose retinal vein occlusion
Usually, we conduct a general ophthalmological examination first with our patients. This includes a visual test using funduscopy, a retinal examination with a slit-lamp.
OCT macula examination
As a next step, an OCT macula examination is carried out, so we can inspect the central retina structures in detail. Quite frequently, a macular edema forms in the aftermath of a retinal vein occlusion. Using this OCT macula type of examination, a macular edema can be be diagnosed exactly.
Additionally, we conduct an OCT angiography. This non-invasive examination (no injection of colourants) allows to exactly display the central and paracentral retinal vessels. Thus, for example, vessels or retinal areas that are not sufficiently supplied with blood can be pointed out and shown in detail.
When appropriate, we can also conduct a conventional vessel examination using a fluorescent colourant – also called fluorescene angiography. This examination is classic angiography. Here, a venous aditus is created at the arm vein into which the fluorescent colourant is injected. This enables us to display the retinal vessels afterwards with a special camera, and we can see exactly, which vessels and which retinal areas are not sufficiently supplied with blood.
Therapy of retinal vein occlusion
Depending on our findings, we treat retinal vein occlusion by laser therapy or by intraocular injection therapy (IVOM therapy).
- IVOM therapy
IVOM therapy is a treatment using injections into the eye. The IVOM therapy is indicated for macular edema treatment.
- Laser therapy
Laser therapy is used to treat vessel occlusions. Ischaemic vessel occlusion means that a certain retinal area is not or not enough perfused with blood. In this case, this area needs laser treatment, because otherwise negative consequences may arise later.
In some cases, if neither macular edema nor ischaema are present, it is wise to wait. Sometimes, a spontaneous regeneration happens. This condition has to be monitored frequently.
We advise retinal vein occlusion patients to see to an internal and cardiological examination as well, to rule out possible sources for embolisation or a coagulation disorder. This can help to avoid a secondary retinal vein occlusion.
Glaucoma as a cause and a symptom
Retinal vein occlusion patients are likely to develop glaucoma, too. Therefore, we put special effort into our examination to diagnose a possible glaucoma, because it can cause further damage if not treated.