Retinal Vein Occlusion

Summary
The retina is the light sensitive layer at the back of the eye- like a film in a camera. A healthy retina is important to help process a clear image. Any problems in the retina, particularly the central area called the macula, result in a reduction of vision.
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A retinal vein occlusion results in sudden loss of part or all of the vision in the affected eye. It is caused be a blockage in the blood vessels to the retina by a clot (thrombus). The clot can cause a central vein occlusion (whole retina affected), a hemi-vein occlusion (half of retina affected) or a branch vein occlusion (part of retina affected).
The effect of a retinal vein occlusion depends on how severe the initial blockage is.

Most people who get a vein occlusion may develop swelling at the back of the eye (called macula oedema) and starvation of of oxygen and nutrients to parts of the retina (called ischaemia). Macular oedema and retinal ischaemia can result in significant visual loss. The presence of macular oedema and ischaemia requires treatment, in the form of laser to the retina and injections to the eye. A very small proportion of people may not need treatment but will need to be carefully monitored to make sure they do not develop further complications.

Ischaemia can occur immediately, a few months or even years after the blockage. When ischaemia does occur, this requires urgent treatment to prevent new retinal blood vessels developing (retinal neovascularisation). These new blood vessels can cause bleeding in the eye resulting in sudden loss of vision or can cause the pressure to build up excessively in the eye resulting in severe pain (rubeotic glaucoma).
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People who have suffered from a retinal vein occlusion may therefore require long term monitoring by their Ophthalmologist. Dr Morjaria has expertise in the management of all aspects or retinal vein occlusion and will be able to fully assess the condition, and advise on the treatment and further follow up of the condition to minimise any visual loss or pain.

What will happen to my vision?
Vision following a retinal vein occlusion can vary considerably. Some people experience a complete loss of vision whilst others may get patchy visual loss.

Early diagnosis and treatment is key to preventing visual loss.
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The prognosis depends on your initial vision. Studies have shown that 80% of people who initially present with very poor vision have a lower chance of improvement compared to those who present with a less than 2 lines drop in vision or better. These people can get a complete return of their vision with minimal or no treatment.

What caused my retinal vein occlusion?
The most common cause is a thrombus (blood clot) which blocks the blood vessel supplying the retina. Other conditions that cause inflammation of the blood vessel can also cause this, such as vasculitis.

Risk factors for developing a retinal vein occlusion?
- Known high blood pressure or undiagnosed high blood pressure
- High cholesterol (>6.5 mmol/l)
- Diabetes mellitus
- Glaucoma
- Blood clotting abnormalities including thrombophilia
- Age
- Smoking
- Rare conditions such as Behçets disease, polyarteritis nodusa, granulomatosis with polyangiitis, acromegaly, Cushing’s syndrome, hypothyroidism

How is the diagnosis made?
Dr Morjaria is a retinal specialist who will examine your eyes to help assess the extent of your condition. Dilating drops will be put in both your eyes to allow assessment of the retina so you will not be able to drive after your appointment.

When you see Dr Morjaria, she will discuss with you the most likely causes of your vein occlusion. You will require blood tests to be taken, blood pressure and sometimes additional tests such as a carotid doppler, which is an ultrasound scan of your neck.

Imaging that will be required are:
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OCT Scan - Optical Coherence Tomography‍
The OCT scan is a quick, non-invasive scan which looks at the layers of the retina focusing on the macula region.

This provides Dr Morjaria with a detailed picture of the back of your eye. Taking regular images enables more accurate monitoring of your condition over time.
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Fluorescein angiogram‍
You may need additional tests that involve having a yellow dye injected into your hand to take pictures of the blood circulation in your eye.

This will allow Dr Morjaria to assess for areas of the eye that are not getting enough oxygen or areas that need laser treatment to prevent bleeding in your eye.
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What is the treatment of macular oedema?
The treatment for retinal vein occlusion is a combination of laser and injections to the eye.

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