What is the retinal vein occlusion treatment?
Treatment depends on the extent of changes. In some retinal vein occlusions, there may be very minimal oedema or swelling of the macular, or no swelling. These are simply observed.
When the macula is involved, and there is a significant macula oedema, we need to treat this quickly. The macula is the central part of the retina that details most of your fine vision, like the ability to read or recognise faces.
The treatment options vary from the retinal laser to injections in the eye that are very similar to the injections used in macular degeneration.
Retinal laser is a safe thing to do when there’s no evident bleeding on the retinal surface. It’s not easy to use earlier on in the course of the disease where there’s frequently quite a bit of bleeding on the retinal surface.
Under these circumstances, it is important to get the injections going as quickly as possible. We know the best outcomes, for example, are if the patient is treated within three months of their symptoms, based on the available evidence.
The different types of drugs that are used vary from Anti-VEGF (Anti-Vascular Endothelial Growth Factor) drugs, which are similar to the drugs we use in macular degeneration to steroid injections that can also reduce swelling and protect the eyes from losing vision.
They have different indications and different advantages. The Anti-VEGF drugs such as Lucentis, Eylea, or Avastin need to be given more frequently. They have very few other side effects such as cataracts and rises in eye pressure, which are the main drawbacks of using steroid drugs.
The advantage of using steroid drugs is that they last for longer and require less frequent injections. Someone who cannot attend the hospital frequently enough for example, or has already had cataract surgery, may opt for the steroid choice of injection. Someone who is younger, and does not want cataract surgery in one eye, (which is what will result from steroid treatment to that eye) may prefer to have the Anti-VEGF drugs.
Laser treatment for retinal vein occlusion still has a very useful place, especially if patients want to have one treatment without the need for repeat treatments.
In branch retinal vein occlusions, it may not reproduce the same increase in vision that an Anti-VEGF drug can give, or a steroid implant can give.
In a rare complication called rubeotic glaucoma, abnormal blood vessels grow and can result in a significant rise in eye pressure. This requires urgent treatment with a laser to prevent further visual loss.