Understanding retinal vein occlusion (RVO) and its impact

Patients Disease management Ophthalmology

Doctor examining eyes of patient in the clinic.

Published

Retinal vein occlusion (RVO) is a condition where a blockage in the blood supply to the retina causes severe, sudden, and painless vision loss.1-5 It affects approximately 28 million people worldwide,5 and is the second most common cause of vision loss due to retinal vascular diseases.3,5

RVO occurs when the blood vessels carrying blood away from the retina are blocked.1-5 and can no longer drain blood, leading to a range of complications, including swelling, bleeding, reduced oxygen supply and fluid leakage into the retina, causing swelling known as macular edema.1-5

There are two main types of RVO:1-6

Branch RVO (BRVO): Occurs when one of the four smaller ‘branches’ of the main central retinal vein becomes blocked.
Central RVO (CRVO): Occurs when the eye’s main central retinal vein becomes blocked.

In people with RVO, the eye produces an elevated level of two specific proteins: angiopoietin-2 (Ang-2) and vascular endothelial growth factors (VEGF). These two proteins are key drivers of the damage and complications related to the disease.7-9

RVO can limit a person’s ability to see, including reading, driving, seeing pictures and even recognising faces.10-15 As a result, a person’s professional and social life may be affected, potentially reducing income, increasing social isolation, and causing depression and anxiety disorders.14,16-21

What are the signs and symptoms of RVO?

Symptoms of RVO can be severe and sudden. Symptoms to be aware of include:1-4,22,23

Sudden, painless blurring or vision loss in part of or all of one eye
Temporary loss of central vision
Central and peripheral visual disturbances
Floaters - dark spots or squiggles in central vision

Illustration of an eyeball showing retinal vein occlusion (RVO) with a magnified view highlighting the two main types of the disease: Branch RVO and Central RVO.

What are the risk factors for RVO?

While RVO affects males and females equally,5 there are several risk factors associated with developing the condition:1-4,22,23

Increasing age - risk increases as people age, especially in those aged 60 and over
High blood pressure (hypertension)
Hardening of the arteries (arteriosclerosis)
Build-up of fatty plaque in arteries (atherosclerosis)
Diabetes
Glaucoma
Smoking
Race - may be more common in Asian and Hispanic populations24

Current treatment options for RVO

The current standard of care for macular edema caused by RVO is medicine injected directly into the eye (known as intravitreal (IVT) injections).1-4,9,25,26 These treatments involve VEGF inhibition or dual inhibition of both VEGF and Ang-2. These medicines work by: reducing inflammation, preventing the development of new blood vessels and limiting leakage from blood vessels into the eye.9,25,26

Unfortunately, many patients do not fully respond to IVT anti-VEGF treatments, they lose response over time, or they show sub-optimal durability,7-9,26,27 meaning that frequent, regular IVT anti-VEGF eye injections - sometimes as often as monthly - may be needed to maintain vision gains and a healthy retinal structure. This schedule can be challenging to maintain, potentially leading to undertreatment and worse outcomes.7-9,26,27

Protecting vision

Getting an annual eye test is the best way to monitor your eye health. However, because RVO can cause sudden vision loss, if you notice any sudden, new, or worsening changes in your vision, contact an eye care professional promptly rather than waiting for a routine appointment.