Retinal Vein Occlusions
Current Treatment Options for Vision Loss due to Retina Vein Occlusions
Retinal vein occlusions (RVO) cause vision loss due to two basic mechanisms:
1. Edema: leakage from the occluded retinal vessels causes edema (swelling) of the retina. Retinal edema may damage retinal photoreceptors. Retinal surgeons often are able to restore vision lost due to retinal edema.
2. Ischemia: loss of circulation or blood supply is called ischemia. Vision loss due to ischemia is permanent and not likely to be restored by any therapy. Most patients suffering from retinal vein occlusions have a combination of edema and ischemia.
The first goal of treatment is to eliminate retina edema (swelling) to prevent additional vision loss. Most patients (more than 50%) will achieve improved vision with successful treatment of their retinal edema (though the vision is not likely to be 100% restored). The extent of the vision improvement depends on the extent of the edema, the degree of the vision loss and the underlying retinal ischemia.
The following treatment plans are available for retinal vein occlusions. Each treatment option has its own unique risks and benefits. Please consult with your retina specialist to determine the best course of treatment for you.
Observation: Certain RVO cases will resolve spontaneously as your circulation may develop accessory vessels to relieve the swelling. Your retinal specialist can give you an idea of your chances for spontaneous resolution of edema based on your exam and diagnostic tests.
Retinal Laser only: This is an option for branch retinal vein occlusions (BRVO) and not central retinal vein occlusions (CRVO). Multiple lasers (anywhere from 1 to 4 treatments, separated by 4 months) are done until the retinal edema has resolved. Laser treatments are safe and offer good rates of vision stabilization. Very few patients treated solely with the laser will experience improved vision. Insurance plans cover this well established treatment.
Injections into the eye (intravitreal injection) with Anti-VEGF drugs in combination with laser: Avastin and Lucentis are specially designed biotechnology drugs that relieve the retinal edema with a high success rate. Typically, intravitreal injections are given on an every 4-6 week basis (you may require 10 injections a year for two years) until all retinal edema (swelling) has resolved. Repetitive and aggressive treatment with avastin or lucentis is necessary to achieve the goal of visual improvement. Retinal laser in combination with intravitreal avastin or lucentis may increase the benefit of these injections. This is a relatively new and safe therapy. Insurance plans may not cover payment for intravitreal avastin and lucentis.
Intravitreal injections with long-acting steroids in combination with laser: This is a highly effective means of resolving edema due to RVO. Typically, patients require 2-4 injections several months apart to resolve all retinal edema. Cataracts often worsen following steroid injections. In addition, there is a 25% chance of eye pressure elevation following steroid injections. Insurance plans cover this treatment plan.
Please consult with your retina specialist to determine the best course of treatment for you.
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