A branch retinal vein occlusion, or BRVO, is an occlusion of one of the retinal veins serving the retina. This is different than a central retinal vein occlusion which involves the entire retina.
Acute painless loss of vision is common, but some patients, as this one, have minimal or no vision loss.
The degree of vision loss is related to the degree in which the macula is involved. In this picture, the macula is barely involved as you can see by the small amount of blood located just above the macula.
An OCT confirms almost no macular edema caused by the branch retinal vein occlusion.
Again, the degree of vision loss with a BRVO directly correlates to the amount of macular edema caused by the BRVO. Yes, that is to say, sometimes, if the macula is uninvolved, or spared, the vision remains perfect and patients are unaware of the occlusion.
In general, treatment for a branch retinal vein occlusion (BRVO) is aimed at treating macular edema caused by the branch vein occlusion.
If the macula is normal and has no swelling (edema), usually no treatment is required. If macular edema is present (and vision is decreased), then treatment to improve the macular edema may be necessary.
(On rare occasion, treatment from complications from “ischemia” caused by the BRVO may be necessary, but your own doctor will know.)
Laser treatment has been the gold standard to reduce macular edema for BRVO, but more recently Ozurdex and Avastin (as well as Lucentis, Eylea) have been highly effective in controlling/improving macular edema caused by Branch Retinal Vein Occlusions.
What Does this Mean?
There is no single perfect treatment for branch retinal vein occlusions. I usually start with the most conservative (least invasive and least likely to cause complications) option of laser treatment, then followed by Avastin and/or Ozurdex. My decision is based upon the extent of the macular edema, duration of symptoms as well as response the response to each single treatment.
Most of the time, I need a combination of treatments to maximally reduce the macular edema. Improvement in vision occurs quite often when treating BRVO and less often with central retinal vein occlusions (CRVO).