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Retinal Artery
& Vein Occlusions

We treat all conditions that effect the retina and macula, including wet and dry macular degeneration, diabetic eye disease, retinal artery and vein occlusions, retinal monitoring for hydroxychloroquine, central serous retinopathy, retinal naevi (moles), floaters, and genetic retinal disorders.

What is a Retinal Vein Occlusion (RVO)?
This occurs when there is a blockage in a vein inside the retina, which is the lining of the back of the eye that acts like the film in a camera. This causes ‘fluid’ to leak into the cells of the retina and can cause reduced vision as a result as the cells cannot function properly

There are 2 types of RVO 

  1. Branch retinal vein occlusion (BRVO) – obstruction of one of the 4 veins, each of which drains about ¼ of the blood supply to the retina. 
  2. Central retinal vein occlusion (CRVO) – a more severe form usually due to obstruction of the main vein.

Causes
This usually occurs in people over 50 years old, although can occur at younger ages. There are some common risk factors other than age; 

  1. Diabetes
  2. High blood pressure 
  3. High cholesterol 
  4. Glaucoma 
  5. Rarely
    Blood disorders making the blood more ‘sticky’. If we think this may be a possibility in your case, we will advise seeing a specialist in blood disorders (haematologist).

What can happen: 

  1. The retinal cells may be damaged by the obstruction to blood flow (retinal ischaemia) – this would need monitoring and possibly retinal laser treatment to stabilise it and prevent further damage to the eye.
  2. ‘Fluid’ may develop in the center part of the retina, which is the most sensitive part responsible for your vision when you are looking straight at an object. This is called ‘macular oedema’ and there are several treatments available.

Tests we perform: Vision, check of eye pressure

  1. Optical coherence tomography (OCT) – scan of the layers of the retina, very good for detecting ‘fluid’ and other problems
  2. Photograph of the retina 
  3. Fluorescein angiography – a yellow dye (fluorescein) is injected in your hand or arm and a series of photographs of the retina are taken with you seated at a machine with your chin in a chin-rest. If you need this, we will explain why this is recommended in your case.

Treatments for Macular Oedema

1. Anti-VEGF medicines – Avastin, Lucentis or Eylea 

These are given by a injection into the eye and initially need monthly treatment until the vision is improved as far as possible. Injections may then need to be given for some time to keep vision stable but the interval between the injections can usually be extended. 

2. Steroid – eg. Ozurdex 

Also given as an injection but is an implant (like a small thread) which releases the drug slowly over several months and does not need repeating for 4-6 months.

What can I expect:

50% of patients should gain significant vision. 

20-30% may not gain vision but vision should be possible to stabilise.

Side-effects of treatment;

All treatments carry risks. The risk of complications from eye injections is very small and injections would not be recommended if the risk of the treatment was greater than the risk of monitoring without treatment and resulting in reduced vision.

AntiVEGF injections
The risk of infection with this treatment is very low but it is very important to report any worsening of the vision or new symptoms – redness, sensitivity to light, pain – that occurs after an injection immediately and if unable to do so by phone, then we would advise attending an Eye Emergency department without delay. 

Increased risk of heart attack and stroke – this is very rare and particularly because the injection is only a tiny dose being administered to the eye. However, if you are at risk anyway because you have other risk factors or have had previous heart attacks or stroke, then there may be a small increased risk. We wait for 3-6 months after a known heart attack or stroke before we would advise treatment.

Steroid injection
These can cause or increase cataract in the eye although usually only if you have repeated injections, not after a single injection. 

May also cause raised eye pressure and we would monitor for this. This occurs in about 25% of patients but only a small number need treatment and usually this is just eye drops which can be stopped once the injection wears off in 4-6 months. Rarely, the pressure may be too high to treat with drops only and a procedure to reduce pressure may be recommended (using laser or very rarely an operation).

  • Thank you so much for the professional and friendly manner with which you dealt with my eye problem.
    The procedure on Thursday went extremely well and I just wanted you to know everything has been fine since – in fact when I removed the dressing my wife said my eye looked ‘amazing’ (NB – that’s the eye she was referring to rather than me!)

  • Dear Mr Walker, with much gratitude for the emergency surgery in September. Hope you get the opportunity to enjoy a G&T..

  • Dear Dr Walker, I want to wish you a Merry Christmas and a very happy New Year. I am grateful for the kind reassurance you gave me before my cataract operation in November. Thanks to your specialist skills I’m confident I will be fully recovered soon. I’m feeling better already! All the best, yours sincerely..

  • Dear Sir, many many thanks to you and your team for the best Christmas gift I have ever received. The restoration of wonderful distance vision in my left eye after cataract surgery, yours in eternal gratitude.

  • Dear Dr Walker, Thank you so much for restoring colour in my life. Your skills are amazing and the care I have received from your nursing staff is very much appreciated

  • Dear Mr Walker, words cannot convey my gratitude to you for putting my world right this morning. You were right, if we put our wants before our needs, we will not have the right treatment that is required for our health. I hope you don’t mind me quoting this when a family or friend get stressed about a medical (or not) procedure that clashes with their life. Nevertheless I am glad the surgery went well as you said, and the bonus I do not have to change my travel plans. For that I am sincerely grateful.

  • Dear Mr Walker, I just wanted to say a personal thank you to you for your kindness, care and reassurance when I was treated by you for the detached retina operation earlier this month. It was an extremely scary time for me which you quickly recognised, so your understanding, as of that of your whole team, is something I feel particularly grateful for. Please accept my sincerest wishes and thanks again.

  • Dear Mr Walker, I would like to thank you and all your colleagues who set time aside to treat me beyond their other commitments to treat me so promptly and so efficiently when I came to the Vitreo retinol clinic on Monday for what might have been merely a routine appointment. I feel extraordinarily fortunate that I was able to be seen immediately in the emergency clinic and to be found a slot for the same day in time for me to get home to Oxfordshire that evening. I should be greatful if you could extend my thanks to your colleagues who helped facilitate this. All the nurses and other staff I encountered were extremely helpful. I feel very privileged to have received such kind and expert treatment in a world reknowned eye hospital.