RVO RETINAL VEIN OCCLUSION A guide to understanding RVO
Take some time to learn about RVO - it may help you hold on to your vision Retinal vein occlusion is a common disorder of the retina and a leading cause of blindness Although RVO cannot be cured, there are treatments available that may help slow down the progression of vision loss and improve your vision. There are also many ways in which you can look after your own wellbeing, manage your risk factors and contribute to the health of your eyes. Take some time to learn about RVO it may help you hold on to your vision. RVO: THE FACTS Veins in your eyes known as retinal veins are an important part of blood circulation and are needed to help you see well. Their main job is to transport blood out of the retina. Retinal vein occlusion (RVO) occurs when one of these veins becomes blocked, usually due to atherosclerosis or a blood clot. This blockage happens without warning and may cause fluid to leak into the macula the part of the eye where focusing occurs. This leads to swelling, called macular edema, which can cause blurred vision and sometimes complete vision loss. RVO can be a serious condition that often leads to sudden vision loss in the affected eye Macula Macular Edema Retina The eyeball with detail of the retina and the area affected by RVO Swollen or Leaky Blood Vessels 1
RVO is the second most common retinal vascular disorder after diabetic retinopathy 1 Worldwide, there are an estimated 16.4 million people affected by RVO 2 The prevalence of RVO varies with age and is most common in people over 65 years old 1 AM I AT RISK? Increasing age (the strongest risk factor for BRVO) Being overweight or obese Cardiovascular disease (eg stroke, coronary artery disease) Diabetes Elevated intraocular pressure Glaucoma High blood pressure High cholesterol Hyperlipidemia Not getting enough exercise Smoking. Some of these risk factors cannot be changed, but others can; wherever possible, consider adapting your lifestyle and habits in order to reduce your risk. You should also get appropriate medical advice and treatment for any of the above ocular or systemic conditions that increase the risk of RVO developing in your eyes. WHAT IS RVO? Central retinal vein occlusion (CRVO). CRVO occurs when the central, or main, retinal vein becomes blocked. In those cases, the whole retina is affected. This type is less common than BRVO, but can lead to sudden, painless loss of vision. 2
Branch retinal vein occlusion (BRVO). Branches of the retinal vein reach out and drain blood from all areas of the retina. BRVO occurs when one of these branches gets blocked. This form of RVO is approximately five times more common than CRVO and, depending on its location, may cause a sudden, painless decrease in vision. If the blocked branch is small or situated in the periphery, the loss of vision may go unnoticed for long periods of time. It is present, nevertheless, and may expand or lead to complications if left untreated. CRVO BRVO Obstructed vein Hemorrhages in the retina Site of vein obstruction Hemorrhages in the retina Normal blood vessels WHAT ARE THE SYMPTOMS OF RVO? RVO can happen without warning and some people with RVO may not notice any symptoms at all, so it is important to get your eyes checked regularly. When symptoms of RVO do occur, they may include: blurred vision distorted vision (objects appear twisted) changes in the perception of colors mild to marked vision loss. The extent of vision loss depends on how much of the retina is affected; vision loss from CRVO tends to be more severe than BRVO because the whole retina is affected. 3
Some studies have shown that RVO may recur in the affected eye, or in the other eye, in up to 15% of patients over a five- year period. Although this has not been studied extensively, there are data to suggest that likelihood of recurrence may be reduced with medical treatment focused on addressing a patient s cardiovascular risk factors. RVO is diagnosed after a complete eye examination, so it is important to make sure you get regular check-ups HOW IS RVO TREATED? You and your eye doctor will determine together which treatment is best for you. Macular edema resulting from RVO is treated either with an anti-vascular endothelial growth factor (anti-vegf) therapy, steroid implants (for CRVO), or laser photocoagulation (for BRVO). In some cases, a combination of the available treatments may be recommended. Treatment options Anti-VEGF therapy Anti-VEGF stands for anti-vascular endothelial growth factor. VEGF is thought to be a trigger for abnormal leaking and growth of the blood vessels in the macula, which leads to edema. Anti-VEGF drugs are injected into your eye to help prevent this from happening. Steroid implants Under general anesthetic, your doctor will inject a small implant into the back of your eye. The implant works by helping to reduce the swelling in the back of your eye, which helps to lessen or prevent more damage to the macula. Laser photocoagulation With this treatment, your doctor will aim a high-energy laser at the areas where leaky blood vessels could affect central vision if not treated. This slows down the leakage of fluid and reduces the amount of fluid in the retina. 4
IT S YOUR VISION HOLD ON TO IT Your vision is precious, so do whatever is within your control to help you hold on to it. There are specific things you can do that may help to delay vision loss: Proactively monitor your vision Visit your eye doctor regularly do not miss any scheduled appointments Learn what visual changes to look for and how best to detect them (eg by closing one eye at a time and examining specially designed shapes or pictures) If you notice a change in your vision, contact your eye doctor immediately Be proactive about vision rehabilitation and the use of visual aids (eg using a magnifiying glass). Take control of your cardiovascular risk factors If you have cardiovascular risk factors, take any prescribed medications as directed by your doctor Keep high blood pressure under control If you have diabetes, keep your blood sugar levels under control If your cholesterol level is too high, talk to your doctor about how you can reduce it Maintain a healthy body weight If you smoke, speak with your doctor about a cessation program and work towards quitting as soon as you can Exercise regularly. Other specific measures to consider if you have RVO are: Remain well hydrated; drink plenty of water If you are under hormone replacement therapy or take oral contraceptives, discuss with your doctor whether these need to be adjusted. 5
Your vision is precious, so do whatever is with your control to hold on to it. There are specific things you can do that may help to delay vision loss Ask for help if you need it. Your loved ones, family, friends, and even others with RVO are there to help you A significant loss of vision can severely impact your ability to function as before, making some things you ve always taken for granted, such as reading, driving, and watching television, extremely difficult. However, the vast majority of patients retain their independence even if, in some cases, this requires the help of visual aids and rehabilitation. Reference: 1. Journal of Ophthalmology Volume 2014 (2014), Article ID 724780, 5 pages http://dx.doi.org /10.1155/2014/724780 2. http://www.aao.org/newsroom/release/20100201.cfm?renderforprint=1& 6
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