Southwest, FL | Central Retinal Vein Occlusion | Cataract & Refractive Institute of Florida
Dr. Croley: Hello and welcome to the Case of the Day. I'm Dr. Croley and today we're going to discuss a case where a patient came in with a complaint of sudden loss of vision in one eye. This was a lady who was in her 80's and it turns out she had a disease called central retinal vein occlusion. We're going to go over what that is and what treatments are available and what can be done about it.
Dr. Croley: Sometimes, unfortunately, not a lot can be done, but we're going to cover what a central retinal vein occlusion is. What happens is, is that the vein that comes into the eye and the artery come together through the optic nerve and then it supplies your retina. The artery pumps blood in and then the veins drain the blood back out. These are right next to each other. What happens in a central retinal vein is, is that the vein becomes occluded here in the optic nerve, so the blood is still being pumped in, but it can't get out, so then these hemorrhages occur into the retina and then damage the retina.
Dr. Croley: There are sort of three different stages or types of central retinal vein occlusion. One is impending central retinal vein occlusion that is, it's just starting, and in those people their vision is still pretty good, but they've now started to notice a loss in vision. Then there is ischemic central retinal vein occlusion and then non-ischemic. Then we'll go over what those things are.
Dr. Croley: What factors relate to having a central retinal vein occlusion? Well, the most common thing is age. Almost everyone who has a central retinal vein occlusion is over age 55. The other thing is that then cardiovascular disease, because hardening of the arteries and all that kind of disease process can put pressure on the vein and stop it from letting the blood out of the eye. Other things can, and this is actually the most common type of vision loss of a retinal disease other than diabetes, so this is the next most common.
Dr. Croley: Other risk factors are if you have a increased viscosity of your blood, you have a elevated cholesterol, and so there's vascular blood abnormalities that may slow down the blood flow, which would contribute to this vein plugging up and maybe smoke injury later. Certainly, this is an older population generally speaking, like I said, but birth control pills, of course, can cause coagulation problems, so if someone was on a supplement of, say progesterone and estrogen after menopause and they had something like this happen, they would probably want to stop that. Those are the common things. Smoking may be related to it, as well. Those would be things that could cause. The other thing that has happened on a rare occasion with central retinal vein occlusions is elevated intraocular pressure. Since the pressure in the eye is elevated, then the vein and blood circulation has trouble going through the eye.
Dr. Croley: There was a famous case in which a Kirby Puckett, a hall of fame baseball player, had glaucoma pressures in the 30s, was not aware of it and suddenly lost vision in one eye. It ended his baseball career because he went blind in that eye and he had a central retinal vein occlusion from an elevated eye pressure or related to an elevated eye pressure.
Dr. Croley: There's two major types, like I said; ischemic and non-ischemic, or a profusion and non-perfusion. The difference is 75% or so is perfusion. That is, there's no loss of blood flow into the eye, so it's non-ischemic. The vein just plugs up, there's hemorrhage and into the retina and usually the person does lose a significant amount of vision and over time that can sort of, after a few months, settle down and there may be new blood vessels that channel around the blockage and then their blood flow, the hemorrhages go away and the blood flow improves, but a lot of times the vision does not because of the damage to the retina. Typically speaking, you would not treat that right away.
Dr. Croley: Then, we have non-profusion where now the artery is also being affected, where we're not profusing blood into the retina and so now the retina is also not having bleeding, but also is not getting enough blood. This is the more severe type with more severe loss and unfortunately can lead to new vessel growth into the eye, even into the front of the eye, which then can cause neovascular glaucoma, which is probably the most severe type of glaucoma. It's very difficult to control. These vessels are very fragile and they bleed and so that is the more severe type of central retinal vein occlusion.
Dr. Croley: The treatment basically is limited if the ischemic part, that is there's not enough profusion, and there starts to form these abnormal blood vessels, then laser treatment is done to try to diminish the growth of those blood vessels. Also, injections of prednisone or cortisone studies that have been done and that has had some success. Probably even better success has been injections of the same chemical or drug that is used for macular degeneration. The wet type of macular degeneration, where it shrinks blood vessels, so if you have abnormal vessels growing into the retina because of lost of blood flow related to the central retinal vein occlusion, then injection of those drugs decrease that. In some cases have improved vision in some cases in some patients.
Dr. Croley: There's really limited treatment. There have been limited successes in those kinds of treatments, though. If you have a sudden loss of vision and you're over age 55, it could be that you have a central retinal vein occlusion and you certainly need to see your eye doctor right away because if the high pressure gets out of control, you develop other complications. The sooner you get to this, the better off you will be.
Dr. Croley: If you have any questions about central retinal vein inclusions, you can certainly contact us at the website and I'll be happy to try to answer those. If you have any other questions, obviously we'll try to answer that as well. If not, then may God grant you healthy eyes and great vision. Have a great day.