5.

1 Retinal Vein Occlusion- An Introduction

In this lesson, we will cover an introduction to retinal vein occlusion.

Note: This lesson contains audio.
At the end of this lesson, please complete the 'quick check' self test  and ensure you achieve 80% or
above before moving onto the next part of the course.

Introduction

General De nition

Incidence

Location and Pathogenesis

Types

Summary

Quick check
Lesson 1 of 7

Introduction

Authors

00:11
Mr Peter K F Addison
–
Consultant Ophthalmic Surgeon
Area(s) of Expertise

Cataracts

Diabetic Retinopathy

Macular Degeneration

Retinal vein occlusion

Uveitis

Extensive experience in the management of all Medical Retina and Uveitis disorders
Languages Spoken – English
Year of First Medical Quali cation - 1997
 
Location of Initial Medical Training -
St John's College, Cambridge University Cambridge University Clinical School

Location of Ophthalmology Training -

Addenbrooke’s Hospital, Cambridge and Moor elds Eye Hospital, London
 
Further Key Experience
Medical Retina and Uveitis Fellowship, Moor elds Eye Hospital (2009-2011)

Date Joined Moor elds - 2006

Membership of Professional/National/Regional Bodies

Fellow Royal College of Ophthalmologists

Current NHS/University Posts

Honorary Consultant Ophthalmic Surgeon, St Thomas' Hospital, London (2013)

Consultant Ophthalmic Surgeon, Moor elds Eye Hospital (2011)

Other Professional Achievements

Awarded Doctorate of Medicine UCL Institute of Ophthalmology (2006)

Clinical Lead Ealing, Hounslow and Kingston Diabetic Eye Screening Programme

Clinical Lead Moor elds Retinal Vein Occlusion Service

 Clinical Audit Lead Moor elds Medical Retina Service

Research Interests - New therapies in Medical Retina and Uveitis

Learning Objectives

1 De ne what an RVO is

2 Classify the main types of RVO

3 Discuss the prevalence of disease, pathogenesis, risk factors and the effects of RVO

4 Describe appropriate Investigations for RVO

5 Discuss treatment options for RVO

Lesson Overview
 00:26

RVO 

General de nition

Incidence

Location and Pathogenesis

Types (CRVO, HRVO, BRVO)

Lesson 2 of 7

General De nition

De nition

00:25

Example of a central retinal vein occlusion

Image courtesy of Peter Addison
Retinal vein occlusion is an obstruction of one of the veins that drains blood away from the retina.

The type of RVO depends on the location of the occlusion

00:47

Slide courtesy of Bayer Pharmaceuticals

Lesson 3 of 7

Incidence
Incidence
 1

RVO is a Major Cause of Vision Loss

00:35

RVO is the second most common sight-threatening retinal vascular disorder (after diabetic
retinopathy)1

RVO is unilateral in most patients2

Can be severe

Possible loss of vision to below driving standards3

As a result, most patients are willing to undergo invasive treatments1

It can be a sign of possible underlying systemic pathology2

[1] Laouri M, et al. (2011); [2] Royal College of Ophthalmologists (2015); [3] UK Government (2017) 
 2

Retinal Vein Occlusion (RVO)

00:43

Estimated worldwide projection: 

16 million people affected in at least one eye2

~520 new cases annually per million population2

Common cause of vision loss in older people

10-year incidence of 1.6% in people aged ≥49 years3

[1] Mitchell et al (1996); [2] Rogers et al (2010); [3] Cugatti et al (2006)

 3

Incidence of RVO Varies With Age

01:32

Main message: 

The incidence of BRVO is much higher in patients aged ≥55 years of age.

Key points:

Advancing age greatly increases the risk of developing BRVO, with the incidence doubling
between the 43–54 years and 65–74 years age groups.

However, it is important to note that BRVO also affects the younger population.

Klein R, et al. (2008)

Lesson 4 of 7

Location and Pathogenesis

Common Sites of Retinal Vein Occlusion1

This gure shows potential sites for BRVO, CRVO, and HRVO.
Click on the markers below to nd out more.

Image courtesy of Yit Yang.

[1] Kiire CA, Chong NV.(2012)

00:54



 

An arteriovenous crossing – a typical site for BRVO

 

Point at which the central retinal vein exits the eye – a common site for CRVO

CRVO occurs in the central retinal vein, e.g. at the point where it exits the eye (blue arrow)

HRVO occurs in the superior or inferior branch of the central retinal vein (also the blue arrow)
Hypothesised Pathogenesis of RVO
It is thought that retinal vein occlusion occurs due to a combination of three factors: 

00:50
Lesson 5 of 7

Types
Types
 1

Different Types of RVO

00:21
 2

Recommended Systemic Investigations for Patients Presenting

with RVO

01:25

Medical investigations should be performed to assess existence of underlying problems. 

 3

Investigations

02:29
 4

Differential Diagnosis

02:46

Consider the above.

Lesson 6 of 7

Summary

00:57

RVO is an obstruction of a vein that drains blood away from the retina

It is a relatively common vascular disorder that can have a severe impact on a patients vision

It can indicate the presence of underlying systemic pathology such as hypertension or

diabetes.
Lesson 7 of 7

Quick check

The quick check is a short test designed for you to check your knowledge of this lesson. We recommend that you
score 80% or above in this quick check before moving onto the next lesson. 
Question

01/03

Match the following occlusion to the location

BRVO Arteriovenous crossings

CRVO Central retinal vein at exit

Superior/inferior branch of central retinal

HRVO
vein
Question

02/03

Which of the following are the most important systemic tests to consider for a patient with an
RVO? Choose all that apply:

Serum glucose

Platelet count

Fasting lipid test

CT scan

Blood pressure
Question

03/03

Which of the following is NOT a recommended ophthalmic investigation in suspected RVO?

Choose one:

RAPD

IOP

ICG imaging

OCT imaging

Visual acuity