Retinal vein occlusion: Epidemiology, clinical manifestations, and diagnosis
- Douglas J Covert, MD, MPH
Douglas J Covert, MD, MPH
- Associated Retinal Consultants
- Traverse City, MI
- Dennis P Han, MD
Dennis P Han, MD
- Jack A. and Elaine D. Klieger Professor of Ophthalmology Director
- Vitreoretinal Section Medical College of Wisconsin
Retinal vein occlusion (RVO) is an important cause of visual loss among older adults throughout the world . RVO is the second most common cause of vision loss from retinal vascular disease, following diabetic retinopathy .
The epidemiology, clinical manifestations, and diagnostic evaluation of RVO will be discussed here. The treatment of retinal vein occlusion, as well as general issues related to retinal artery occlusion, are discussed separately. (See "Retinal vein occlusion: Treatment" and "Central and branch retinal artery occlusion".)
The anatomic classification of RVO is derived from the fundoscopic appearance of the eye and includes three main groups depending on the location of venous occlusion: branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), and hemiretinal vein occlusion (HRVO).
●BRVO occurs when a vein in the distal retinal venous system is occluded, leading to hemorrhage along the distribution of a small vessel of the retina (picture 1).
●CRVO occurs due to thrombus within the central retinal vein at the level of the lamina cribrosa of the optic nerve, leading to involvement of the entire retina (picture 2). The lamina cribrosa is the connective tissue "sieve" consisting of holes through which the nerve fibers pass from the retina to the optic nerve (figure 1).
- Rogers S, McIntosh RL, Cheung N, et al. The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology 2010; 117:313.
- Cugati S, Wang JJ, Rochtchina E, Mitchell P. Ten-year incidence of retinal vein occlusion in an older population: the Blue Mountains Eye Study. Arch Ophthalmol 2006; 124:726.
- Klein R, Klein BE, Moss SE, Meuer SM. The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc 2000; 98:133.
- Mitchell P, Smith W, Chang A. Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol 1996; 114:1243.
- Risk factors for branch retinal vein occlusion. The Eye Disease Case-control Study Group. Am J Ophthalmol 1993; 116:286.
- Risk factors for central retinal vein occlusion. The Eye Disease Case-Control Study Group. Arch Ophthalmol 1996; 114:545.
- Rehak M, Rehak J, Müller M, et al. The prevalence of activated protein C (APC) resistance and factor V Leiden is significantly higher in patients with retinal vein occlusion without general risk factors. Case-control study and meta-analysis. Thromb Haemost 2008; 99:925.
- Newman-Casey PA, Stem M, Talwar N, et al. Risk factors associated with developing branch retinal vein occlusion among enrollees in a United States managed care plan. Ophthalmology 2014; 121:1939.
- Bowers DK, Finkelstein D, Wolff SM, Green WR. Branch retinal vein occlusion. A clinicopathologic case report. Retina 1987; 7:252.
- Zhao J, Sastry SM, Sperduto RD, et al. Arteriovenous crossing patterns in branch retinal vein occlusion. The Eye Disease Case-Control Study Group. Ophthalmology 1993; 100:423.
- Weinberg D, Dodwell DG, Fern SA. Anatomy of arteriovenous crossings in branch retinal vein occlusion. Am J Ophthalmol 1990; 109:298.
- Duker JS, Brown GC. Anterior location of the crossing artery in branch retinal vein obstruction. Arch Ophthalmol 1989; 107:998.
- Green WR, Chan CC, Hutchins GM, Terry JM. Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases. Trans Am Ophthalmol Soc 1981; 79:371.
- Finkelstein D. Ischemic macular edema. Recognition and favorable natural history in branch vein occlusion. Arch Ophthalmol 1992; 110:1427.
- Natural history and clinical management of central retinal vein occlusion. The Central Vein Occlusion Study Group. Arch Ophthalmol 1997; 115:486.
- Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group. Am J Ophthalmol 1984; 98:271.
- Hayreh SS, Podhajsky PA, Zimmerman MB. Natural history of visual outcome in central retinal vein occlusion. Ophthalmology 2011; 118:119.
- Werther W, Chu L, Holekamp N, et al. Myocardial infarction and cerebrovascular accident in patients with retinal vein occlusion. Arch Ophthalmol 2011; 129:326.
- Cugati S, Wang JJ, Knudtson MD, et al. Retinal vein occlusion and vascular mortality: pooled data analysis of 2 population-based cohorts. Ophthalmology 2007; 114:520.
- Baseline and early natural history report. The Central Vein Occlusion Study. Arch Ophthalmol 1993; 111:1087.
- Nobre Cardoso J, Keane PA, Sim DA, et al. Systematic Evaluation of Optical Coherence Tomography Angiography in Retinal Vein Occlusion. Am J Ophthalmol 2016; 163:93.
- Janssen MC, den Heijer M, Cruysberg JR, et al. Retinal vein occlusion: a form of venous thrombosis or a complication of atherosclerosis? A meta-analysis of thrombophilic factors. Thromb Haemost 2005; 93:1021.
- Napal JJ, Neila S, Pérez-Montes R, et al. The role of coagulation disorders in patients with retinal vein occlusion. QJM 2016; 109:97.
- Risk factors
- CLINICAL MANIFESTATIONS
- NATURAL HISTORY
- Visual acuity
- Ocular neovascularization
- Cardiovascular disease
- DIAGNOSTIC EVALUATION
- Eye examination
- - Visual acuity
- - Fundus examination
- Fluorescein angiogram
- Optical coherence tomography
- Additional testing
- SUMMARY AND RECOMMENDATIONS