Managing Retinal Vein Occlusion

Managing Retinal Vein Occlusion

August 02, 2021

Retinal vein occlusion happens when a blood clot blocks the vein. Sometimes it happens because the veins of the eye are too narrow. It is more likely to occur in people with diabetes, and possibly high blood pressure, high cholesterol levels, or other health problems that affect blood flow.

There are two types of RVO:

  • Central retinal vein occlusion (CRVO) is the blockage of the main retinal vein.
  • Branch retinal vein occlusion (BRVO) is the blockage of one of the smaller branch veins.

Retinal vein occlusions (RVO), a heterogeneous group of disorders that have in common impaired venous return from the retinal circulation, can result in significant vision loss.

Classification of RVO can be broken down into branch retinal vein occlusion (BRVO), hemiretinal vein occlusion (HRVO), and central retinal vein occlusion (CRVO), depending on the site of the obstruction.

Macular edema associated with RVOs may be managed with anti-VEGF therapy, steroids, and/or laser. Delays in treatment initiation, individual patient response to different anti-VEGF therapies, and inadequate patient adherence to treatment or access in the era of COVID-19 all contribute to worse outcomes in real-world settings.

Findings from clinical studies have shown that anti-VEGF therapies can have different functional, anatomic, or visual outcomes under select circumstances. Moreover, specific baseline characteristics have been associated with improved visual acuity and central subfield thickness outcomes in eyes treated with anti-VEGF agents.

Identifying which factors are associated with different outcomes can be useful in counseling patients and managing patient expectations. Individualized treatment regimens are often necessary to ensure that clinical outcomes are not compromised.

Although anti-VEGF therapy is the standard of care for RVO, patients who respond poorly to initial treatment may require a more personalized approach. Switching to an alternate anti-VEGF agent is often the recommended first step, and many factors must be considered when switching anti-VEGF therapy, including when to switch and why.

There also are other options, such as steroid implants or combination anti-VEGF and steroids, that may be appropriate in select patients. Examining clinical evidence supporting switching is important with regards to improving patient outcomes.

With new interventions to treat retinal diseases on the horizon, ophthalmologists must have a clear understanding of the clinical evidence leading to the approval of new agents, devices, and therapies and know the potential benefits and risks of new interventions and their use in clinical practice.