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Retinal Vascular Disease 

What is Retinal Vascular Disease?

A Retinal Vein Disease or Retinal Vascular Occlusion is a blockage of a vein in the retinal bleeding and leakage of fluid into the retina.

Visual loss varies depending on the severity of the blockage.

Who is at risk of Retinal Vein Occlusions?

Retinal Vein Occlusions are more common in older patients. High blood pressure is the strongest risk factor, but other cardiovascular risk factors such as smoking, high cholesterol and diabetes may contribute. Less commonly other blood disorders need to be considered.

Symptoms of Retinal Vein Occlusions

Mild cases may have no symptoms and may be picked up incidentally. These may not require treatment particularly if the macula is not involved. In other cases there may be blurred vision. In the most severe cases the eye becomes red, painful and blind. 

Types of Retinal Vein Occlusions

Central Retinal Vein Occlusion

Central Retinal Vein Occlusion occurs when the major central retinal vein, draining blood from the entire retina, is blocked. This results in poor blood flow throughout the retina and can cause severe loss of vision.

Branch Retinal Vien Occlusion

When branches of the central retinal vein become blocked, it is called Branch Retinal Vein Occlusion (BRVO). 

A smaller area of the retina is usually affected. 

Visual loss varies but is not as severe as with a Central Retinal Vein Occlusion.

How is Retinal Vein Occlusion Diagnosed?

An RVO is typically diagnosed by examining the retina after dilating the pupils. Your Ophthalmologist will be able to recognise the characteristic pattern of haemorrhages that occurs in a CRVO or BRVO. 

Further tests include  Optical Coherence Tomography (OCT) to quantify the degree of macular swelling (Macular Oedema).

Fluorescein Angiography and OCT Angiography are useful to identify the degree of underlying damage to the circulation and in some cases, to guide laser therapy.  

Blood tests may be ordered to help determine the underlying cause of the condition. You may be referred back to your general medical practitioner or a physician for such investigations.

How is Retinal Vein Occlusion treated?

The treatment recommended will depend on the severity of the Retinal Vein Occlusion and the effect on vision.

Mild cases of Retinal Vein Occlusion may require no treatment. A small proportion of RVOs do settle spontaneously.

More severe cases in which vision is reduced, may require treatment, such as:

• Intravitreal Anti-VEGF Injections

• Intravitreal Steroid Injections

• Retinal Laser Treatment

Successful treatment of Retinal Vein Occlusion may take months or even years in severe cases.

Central Retinal Artery Occlusion (CRAO)

Central Retinal Artery Occlusion (CRAO) is an ocular and medical emergency concerning the eyes and usually occurs in conjunction with a cerebral stroke. It requires immediate attention.

CRAO is a disease occurs when the flow of blood through the central retinal artery is blocked (occluded). 

Cerebral retinal artery occlusion usually occurs in men, between 60 – 65 years of age.

Central retinal artery occlusion occurs due to obstruction to the retinal blood flow. There are several different causes of this occlusion, these can include:

carotid artery atherosclerosis,

thrombus formation or an embolus causing occlusion, 

trauma, or

vasculitis.

There are multiple risk factors and causes associated with CRAO and most of them are identical to ischemic stroke causes. These causes are:

• High blood pressure (Hypertension)

• Obesity

• Diabetes

• Smoking

• High cholesterol (Hyperlipidemia)

• Coagulopathy disorders

• Male gender

• Age above 60

• Cardiovascular disease

When the retina gets oxygen-starved during the blockage, severe vision loss occurs in the affected ischemic area.

The telltale presenting complaint of CRAO is a sudden onset, painless, persistent monocular vision loss. 

This vision loss can range from the inability to count fingers to light perception only in 90% of the cases.