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Branch Retinal Vein Occlusion (BRVO): Symptoms, Diagnosis and Treatment

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Branch retinal vein occlusion (BRVO) manifests as blurring or vision loss in all or part of one eye. If you experience this, you should seek help as soon as possible.

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What Is Branch Retinal Vein Occlusion (BRVO)?

BRVO is caused by the blockage of small veins (branch veins) in the eye. This blockage causes blood and other fluids to spill into the retina, affecting vision. Serious blockages can eventually cause nerve cells in the eye to die, further impacting vision.

Seeing a doctor as soon as you think you might have BRVO is important. The condition can worsen over time and lead to blindness in the affected eye. Getting help sooner rather than later increases the chance that some of your sight may be restored.

Branch Retinal Vein Occlusion Symptoms

Branch Retinal Vein Occlusion (BRVO) typically affects one eye and can cause the following symptoms:

  • Sudden blurring or loss of vision: This is usually the first symptom people notice. Vision may be partially or completely lost in the affected eye.
  • Distorted vision: Straight lines may appear curved or wavy.
  • Blind spots: You may notice areas of your vision where you can’t see anything.
  • Floaters: These appear as small, dark shapes that ‘float’ in your field of vision.
  • Changes in color perception: Colors may appear washed out or less vibrant.

These symptoms may occur suddenly or develop gradually over a few hours or days. It’s important to note that BRVO is often painless, so any sudden changes in vision should prompt an immediate visit to an ophthalmologist or optometrist. These healthcare professionals can examine your eyes and determine if BRVO or another condition is the cause of your symptoms.

If the condition does not affect an area near the center of the eye, it may occur with no symptoms or minimal symptoms. This can cause the condition to go undetected. In rare cases, undetected vein occlusions may lead to visual floaters, as blood leaks into the eye.

BRVO Diagnosis

The earliest signs of branch retinal vein occlusion are the symptoms noted above. Even if you experience only mild swelling or occasional visual floaters, you should see an ophthalmologist. BRVO is not curable but it is treatable. Identifying it is important, as it can get worse with time.

A doctor testing for BRVO can perform tests to more conclusively confirm if you have the condition. First, a fluorescein angiography (FA) test is performed. This involves injecting special dye into the arm, which allows a specialized camera to more easily see how your blood is circulating. A doctor will then look for the following in your eye:

  • Poor circulation
  • Swelling
  • Abnormal growth of new blood vessels in the retina

Once a doctor has determined if you likely have BRVO, an optical coherence tomography (OCT) test may be performed. This noninvasive imaging test uses light to make an 3D image of your eye that will be useful in your evaluation and treatment

BRVO Treatment

BRVO is incurable. Even with treatment, not every patient will see improvement. However, most people will see at least some improvement in their vision.

Treatment for BRVO typically focuses on managing the symptoms and preventing further vision loss. It’s also essential to treat any underlying conditions that may have contributed to the occlusion, such as hypertension or diabetes.

  • Injections: Medications may be injected into the eye to reduce swelling and improve blood flow. These often include anti-vascular endothelial growth factor (anti-VEGF) agents or corticosteroids.
  • Laser Therapy: Laser photocoagulation is a treatment option used to seal off leaking blood vessels and reduce swelling in the retina, preventing further vision loss.
  • Vitrectomy: In some severe cases, a procedure called a vitrectomy might be needed. This involves removing some or all of the vitreous humor (the clear gel that fills the eye) to reduce pressure and improve blood flow.
  • Management of Underlying Conditions: As part of the treatment strategy, any conditions that may have contributed to the BRVO, like hypertension, high cholesterol, or diabetes, need to be well managed. This often involves a coordinated care approach with other healthcare providers.
  • Observation: In some cases, if the occlusion is not severe and there’s minimal edema or hemorrhage, the eye care professional might choose to observe the condition while managing underlying risk factors. Some BRVO can resolve spontaneously over time.

The choice of treatment depends on factors like the patient’s overall health, the severity of the BRVO, and the presence of any complications. Regular follow-ups with an ophthalmologist or retina specialist will be necessary to monitor the condition and adjust treatment as needed. Remember, early detection and treatment can help preserve vision in people with BRVO.

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What Causes Branch Retinal Vein Occlusion?

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Your eye has one main artery and one main vein. These both branch out, helping to supply the eye with blood. Whether it’s due to a blood clot, narrowed blood vessels, or a thickened artery crossing over a branch vein, BRVO happens when something begins to block a branch retinal vein.

Blood and other fluid can then lead out of the blocked vein, which can swell the macula (an area of the eye very important for detailed vision). It can also result in the macula receiving inadequate blood flow. This is called macular edema.

The symptoms commonly associated with branch retinal vein occlusion are due to this effect on the macula. This is also why it’s important to see a doctor if you think you might have this condition. Poor circulation and minute amounts of swelling may still do some permanent damage. You could potentially lose much more vision in the affected eye without treatment as the macula is further affected.

Some conditions that make one more likely to deal with BRVO include the following:

  • High blood pressure
  • Obesity
  • Diabetes
  • Heart disease
  • Blood clotting issues
  • Glaucoma
  • Age

Most people affected by BRVO are over the age of 50. Data does not suggest that there is a difference in risk between men and women, and people of different races are also generally affected at similar rates.

Managing Risks

While not every risk factor of BRVO is within your control, such as age, others are. Generally speaking, engaging in behaviors and habits that are healthy for your heart and circulatory system will help to reduce your risk of getting BRVO.

Some behaviors that can help control your risk include:

  • Maintaining a low-fat diet.
  • Keeping a healthy weight.
  • Regularly exercising.
  • Avoiding activities that negatively affect your circulatory system, like smoking.

Rare Complications

Although rare, branch retinal vein occlusion can sometimes lead to the development of abnormal new blood vessels (neovascularization). This generally occurs when BRVO affects an area of the eye that does not significantly affect vision, causing it to go undetected. This is why any visual floaters, as discussed above, should not be ignored.

Left untreated, neovascularization can lead to a host of vision problems.

References

  1. Retinal Vein Occlusion. (April 1, 2019). MedlinePlus.
  2. What Is Branch Retinal Vein Occlusion (BRVO)? (November 16, 2018). American Academy of Ophthalmology (AAO).
  3. Branch Retinal Vein Occlusion (BRVO) Treatment. (November 16, 2018). American Academy of Ophthalmology (AAO).
  4. The Prevalence of Retinal Vein Occlusion: Pooled Data from Population Studies from the United States, Europe, Asia, and Australia. (February 1, 2011). American Academy of Ophthalmology (AAO).
  5. Branch Retinal Vein Occlusion. (2016). American Society of Retina Specialists.
  6. Glossary. American Society of Retina Specialists.
  7. Who Is at Risk for Branch Retinal Vein Occlusion (BRVO)? (November 16, 2018). American Academy of Ophthalmology (AAO).

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