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Floaters After Cataract Surgery

Floaters After Cataract Surgery: Decoding Causes, Treatments, And Future Complications

July 9, 2024/0 Comments/in Cataract Surgery /by Armadale Eye Clinic Team

Cataract surgery is a highly successful eye procedure that restores vision clarity for millions of people worldwide. However, some patients experience new or increased floaters following surgery. While often harmless, floaters can be unsettling, and it’s crucial to understand their potential causes and when to seek professional help.

This article delves into the phenomenon of floaters after cataract surgery, exploring their causes, symptoms, treatment options, and potential complications if left untreated.

Myodesopsia: Understanding The Physiological Origins Of Eye Floaters

Within the realm of ophthalmology, a frequent presentation patients describe is the presence of myodesopsia, more commonly known as floaters. These subjective visual phenomena manifest as fleeting opacities that drift across the visual field, often likened to cobwebs, specks, or squiggly lines. Their presence can be unsettling, prompting patients to seek clarification regarding their origin and potential significance.

Vitreous humour plays a critical role in the eye’s structure and function. This transparent, gel-like substance fills the vitreous cavity, the posterior chamber of the eye located between the lens and the retina. The vitreous humour serves several crucial purposes:

Maintaining The Globe’s Shape: The globe acts as a hydrostatic structure, helping the eyeball maintain its spherical form, which is essential for optimal visual function.
Supporting The Retina: The vitreous humour provides a supportive scaffold for the delicate retina, the light-sensitive layer at the back of the eye responsible for converting light signals into electrical impulses.
Light Transmission: Ideally, the vitreous humour is transparent, allowing light to pass through unimpeded and reach the retina’s photoreceptor cells.

However, with age, the vitreous humour undergoes a natural liquefaction process. This phenomenon, known as syneresis, can lead to the formation of microscopic condensations within the gel. These condensations create shadows on the retina as they move freely within the vitreous cavity, corresponding to the perception of floaters.

The size, number, and morphology of floaters can vary considerably between individuals. Some patients may only experience tiny floaters that look like dots, while others may describe a more extensive network of wispy, cobweb-like structures. It’s important to note that floaters themselves are not inherently harmful and do not directly impact the health of the ocular surface.

However, a sudden increase in the number or size of floaters, particularly accompanied by flashes of light, warrants immediate ophthalmic evaluation. This could indicate a retinal problem requiring prompt medical attention to prevent potential vision loss.

The Influence Of Cataract Eye Surgery On Vitreous Dynamics And Floater Perception

Cataract surgery, a highly successful procedure for restoring vision clarity, can sometimes lead to a noticeable change in the perception of floaters. This condition can be attributed to two primary mechanisms related to the interaction between the surgical intervention and the vitreous humour.

Posterior Vitreous Detachment (PVD)

The vitreous humour, a transparent gel that fills the eye’s posterior chamber, plays a crucial role in maintaining the globe’s shape and transmitting light to the retina. During cataract surgery, the surgeon gains access to the eye’s interior through a small incision. While the surgical technique is meticulous and strives for minimal disruption, manipulating the ocular tissues can sometimes initiate a process known as posterior vitreous detachment (PVD).

PVD involves the partial or complete separation of the vitreous humour from the retinal surface. This detachment can cause microscopic tears or disturbances within the vitreous gel, forming new vitreous floaters. Additionally, the vitreous movement during PVD can dislodge preexisting condensations or strands within the gel, making them more noticeable and disruptive to improved vision.

Visibility Of Preexisting Floaters

Cataracts are opacifications of the natural lens of the eye that can significantly reduce the quality of vision by scattering incoming light. Patients with cataracts often experience foggy vision, glare, and diminished visual acuity. In such cases, preexisting floaters within the vitreous humour may be less noticeable due to the overall reduction in light transmission through the clouded lens.

Following successful cataract surgery, removing and replacing the opaque lens with a clear artificial lens (called an intraocular lens) significantly improves light transmission to the retina. With increased clarity and visual acuity, patients may become more aware of preexisting floaters previously obscured by the cataract. This heightened awareness can lead to a perception of increased floater activity, even though the floaters themselves may not have changed in number or size.

It’s important to note that not everyone who undergoes cataract surgery will experience a change in their perception of floaters. The likelihood of PVD and its associated floater formation depends on various factors, including the patient’s age, the preexisting condition of the vitreous, and the surgical technique employed.

Spotting The Difference: Normal Floaters Vs. Warning Signs

Floaters after cataract surgery are usually nothing to worry about. They typically appear as tiny dots, circles, or lines that drift across your vision, especially noticeable against bright backgrounds like a clear sky. The number and size of these floaters can vary, and they tend to move smoothly with your eye movements.

However, some signs require immediate attention from your eye doctor:

Sudden Flashes Of Light: This could be a sign of a retinal tear, which can eventually lead to vision loss if left untreated.
Curtain-Like Shadow Or Vision Loss: A dark shadow or significant worsening of blurred vision, especially in your peripheral vision, could indicate a retinal detachment or a serious eye emergency.
Persistent Eye Pain: While some discomfort after surgery is normal, persistent pain needs to be checked by your doctor.

Potential Complications Of Untreated Floaters

While most floaters are harmless, in rare cases, they can be a sign of a more troublesome issue, such as a retinal tear or retinal detachment.

Retinal Tear: A retinal tear occurs when a small tear develops in the retina. Although a retinal tear itself may not cause immediate vision loss, it can allow vitreous fluid to leak behind the retina, potentially leading to retinal detachment.
Retinal Detachment: A retinal detachment occurs when the eye’s retina pulls away from the underlying tissue, where it receives nutrients and processes light signals. This is a grave medical emergency that requires immediate treatment to preserve vision.

If left untreated, a retinal tear or detachment can ultimately lead to permanent vision loss. Therefore, seeking immediate medical care is crucial if you experience any new or worsening symptoms alongside floaters, such as sudden flashes of light, vision loss, or a dark curtain obscuring your vision.

Addressing Potential Complications Of Persistent Floaters

If your doctor diagnoses a retinal tear or detachment, they will recommend the most appropriate treatment course based on the severity of the condition. Here’s an overview of potential treatment options:

Laser Panretinal Photocoagulation (PRP)

This minimally invasive surgery uses advanced laser technology to make small burns around the retinal tear, seal it, and prevent further detachment.

Cryopexy

Similar to laser photocoagulation, cryopexy uses extreme cold to freeze the tissue surrounding the tear, creating a scar that seals the break.

Pneumatic Retinopexy

For some tears, a gas bubble is injected into the vitreous cavity to tamponade (press against) the retina and allow it to reattach.

Vitrectomy

A vitrectomy may be necessary in cases of severe retinal detachment or when other treatments are not feasible. This surgical treatment involves removing and replacing the vitreous humour with a saline solution. During the surgery, the surgeon can then repair the retinal tear and reattach the retina.

Argon Laser Retinopexy

This specific type of laser treatment is a valuable tool in managing retinal tears, particularly those identified early. During the procedure, a concentrated beam of argon laser light is directed at the retinal tissue surrounding the tear. The laser creates small burns, which stimulate scar tissue formation. This scar tissue helps to seal the tear and prevent further detachment.

Frequently Asked Questions (FAQs)

Can I prevent floaters after cataract surgery?

Unfortunately, there’s no guaranteed way to prevent floaters after cataract surgery. However, choosing an experienced ophthalmologist with a gentle surgical technique can minimise the risk of PVD and associated floaters.

How long do floaters typically last after cataract surgery?

Most floater symptoms improve or disappear completely within a few weeks to a few months.

Should I be concerned if I experience blurry vision after cataract surgery along with floaters?

Some mild blurry vision is common following cataract surgery as your eye adjusts to the new lens. However, if the blurry vision is significant, worsens progressively, or coincides with new or increased floaters, contact your eye doctor for a follow-up appointment to rule out any underlying issues.

What lifestyle changes can help manage floaters?

While there’s no way to directly eliminate floaters, staying hydrated can help keep the vitreous healthy and potentially reduce their visibility. Additionally, protecting your eyes from ultraviolet (UV) rays by wearing sunglasses that block harmful UVA and UVB rays is essential for overall eye health.

Can I still exercise after cataract surgery if I have floaters?

Generally, you can resume most activities, including exercise, after cataract surgery following your doctor’s guidance. However, if you experience any worsening of floaters or other concerning symptoms during exercise, stop the activity and seek medical advice.

Beyond Surgery: Maintaining Optimal Vision After Cataract Surgery

Floaters are a relatively common occurrence after cataract surgery. While often benign and temporary, it’s crucial to be aware of the potential causes and symptoms of more serious complications. If you experience sudden changes in your vision, flashes of light, or a dark curtain obscuring your vision alongside floaters, contact your eye doctor immediately. Early diagnosis and treatment of retinal problems can significantly improve the chances of preserving your vision.

By understanding the causes and potential complications of floaters after cataract surgery, you can be a proactive participant in your eye health and ensure the best possible outcomes following your surgery. Remember, regular eye checkups with your ophthalmologist are essential for maintaining good vision throughout your life.

Contact Armadale Eye Clinic, Armadale, 3143, VIC, at (03) 9070 5753 to free your vision from floaters and enjoy 100% clear vision.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Sources

Dunbar, Mark T. “Do Symptoms Signal Retinal Tear? This Patient Presented With Loss of Vision, Flashes and Floaters, What Is the Likely Diagnosis?” Document – Gale Academic OneFile, 15 June 2011, go.gale.com/ps/i.do?id=GALE%7CA260281530&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=1930160X&p=AONE&sw=w&userGroupName=anon%7E14b2bdf1&aty=open-web-entry.

“Eye Floaters – Symptoms and Causes” Mayo Clinic, 7 Sept. 2022, www.mayoclinic.org/diseases-conditions/eye-floaters/symptoms-causes/syc-20372346.

Proctor, Jason G. Goldman /. Illustration by Adam. Why Do You Get ‘Eye Floaters’? 24 Feb. 2022, www.bbc.com/future/article/20160113-why-do-you-get-eye-floaters.

Sebag, J. “Vitrectomy for Vision Degrading Myodesopsia.” Ophthalmology Retina, vol. 5, no. 1, Jan. 2021, pp. 1–3. https://doi.org/10.1016/j.oret.2020.08.013.

Seladi-Schulman, Jill, PhD. “Floaters After Cataract Surgery: What They Mean and What to Do Next.” Healthline, 2 Mar. 2021, www.healthline.com/health/eye-health/floaters-after-cataract-surgery.

The American Society of Retina Specialists. “Posterior Vitreous Detachment – Patients – the American Society of Retina Specialists.” ASRS, www.asrs.org/patients/retinal-diseases/9/posterior-vitreous-detachment.

“What Is the Probability of Developing Retinal Tears/Detachment After Onset of Floaters and Flashes Has Occurred?” American Academy of Ophthalmology, 8 Feb. 2018, www.aao.org/eye-health/ask-ophthalmologist-q/floaters-retinal-tear.

branch retinal vein occlusion melbourne

Veins of Vision: Navigating the Complexities of Branch Retinal Vein Occlusion

February 17, 2024/0 Comments/in Retinal Surgery /by Armadale Eye Clinic Team

Branch Retinal Vein Occlusion (BRVO) is a significant ocular condition that affects the retinal vein, specifically the branch retinal vein, leading to vision problems. This blog post aims to provide a comprehensive understanding of BRVO, its causes, symptoms, and available treatments, focusing on the Australian context. We’ll also discuss related conditions such as Central Retinal Vein Occlusion (CRVO) and Macular Oedema.

What is Branch Retinal Vein Occlusion?

BRVO occurs when the blood flow through a retinal vein, one of the tiny blood vessels in the retina, is obstructed. This obstruction leads to the accumulation of blood and fluid in the retina, causing retinal oedema and sometimes macular oedema, a significant cause of vision loss in BRVO patients.

Types of Branch Retinal Vein Occlusion

Branch Retinal Vein Occlusion (BRVO) is primarily categorised based on the location and extent of the vein occlusion in the retina:

Major BRVO: Involves the occlusion of one of the major branch retinal veins. It’s more common and typically has more significant visual implications.
Macular BRVO: Affects the veins within or near the macula, the central area of the retina responsible for detailed vision. It can lead to macular oedema and central vision loss.

Causes of Branch Retinal Vein Occlusion

The primary cause of BRVO is a blockage in the retinal vein, often due to a blood clot. This obstruction can be influenced by various factors:

Venous Compression: Arteriovenous crossings where arteries and veins share a common sheath can lead to compression of the vein by the artery.
Blood Vessel Wall Changes: Age-related or disease-induced changes in the blood vessel wall can lead to narrowing and clot formation.
Blood Hypercoagulability: Conditions that increase the tendency of blood to clot can precipitate BRVO.

Risk Factors for Branch Retinal Vein Occlusion

There are specific conditions and lifestyle choices that can heighten the likelihood of developing BRVO:

Age: BRVO is more common in individuals over the age of 50.
Hypertension: High blood pressure is a significant risk factor, as it can cause changes in the blood vessels, including those in the eye.
Diabetes: Prolonged diabetes can lead to damage in the blood vessels, including the retinal veins.
Hyperlipidemia: High levels of fats in the blood can contribute to blood vessel blockages.
Glaucoma and Ocular Hypertension: Elevated pressure inside the eye can compress the retinal vein.
Smoking: Tobacco use can affect blood circulation and vessel health, increasing the risk of BRVO.
Blood Disorders: Conditions that affect blood clotting or blood cell characteristics can predispose individuals to vein occlusions.
Cardiovascular Disease: Heart conditions that affect blood flow and vessel health can also impact the retinal veins.
Inflammatory Conditions: Systemic inflammatory diseases like lupus can increase the risk of blood vessel blockages.

Symptoms of Branch Retinal Vein Occlusion

The symptoms of BRVO can vary depending on the severity and location of the occlusion, but common signs include:

Visual Changes: These often occur suddenly and may include blurred vision, a sudden decrease in vision, or seeing floaters (small, dark shapes in the field of vision).
Visual Field Loss: Partial loss of vision or a blind spot in one part of the field of vision, corresponding to the area of the retina affected.
Distorted Vision: Also known as metamorphopsia, where straight lines appear wavy or bent.
Pain or Pressure: Rare in BRVO but can occur, especially if there is an associated rise in eye pressure.

Further Insights into the Diagnosis of Branch Retinal Vein Occlusion

Diagnosing Branch Retinal Vein Occlusion (BRVO) involves a series of examinations and tests to assess the health of the retina and the extent of the occlusion. Here’s a more detailed look at the diagnostic process:

Detailed Eye Examination

Ophthalmoscopy: This is a fundamental part of the eye exam where the doctor looks at the structures of the eye, including the retina, using a special magnifying lens. Signs of BRVO, such as retinal haemorrhages, blocked veins, and swelling, can be seen.
Slit-Lamp Biomicroscopy: This instrument allows the eye doctor to view the retina under high magnification and in three dimensions, providing detailed information about the status of the retinal blood vessels and any associated oedema or haemorrhages.

Imaging Tests

Fluorescein Angiography (FA): During this examination, a fluorescent dye is introduced into a vein in the arm, capturing images as it traverses the retinal circulation. FA can show blockages in the retinal vessels, areas of non-perfusion (lack of blood flow), and locations of leakage.
Optical Coherence Tomography (OCT): OCT provides high-resolution cross-sectional images of the retina, allowing for the assessment of macular oedema and the detailed structure of the retina.

Visual Function Tests

Visual Acuity Test: This test measures the clarity or sharpness of vision. A decrease in visual acuity may indicate damage to the retina due to BRVO.
Visual Field Test: This test assesses the entire field of vision, including peripheral vision, which can be affected by BRVO.

Additional Tests

Blood Pressure Measurement: Elevated blood pressure poses a substantial risk for BRVO. Hence, evaluating blood pressure forms an integral component of the assessment process.
Blood Tests: In some cases, especially if a systemic cause is suspected, blood tests may be conducted to check for diabetes, high cholesterol, or blood clotting disorders.

Importance of Early Diagnosis

Early detection and diagnosis of BRVO are vital for preventing long-term damage to the retina and irreversible vision loss. If you experience any symptoms of BRVO, it’s important to see an eye specialist immediately. The earlier the treatment starts, the better the chances of preserving vision and preventing complications such as chronic macular oedema or neovascular glaucoma.

Regular eye exams are also crucial, especially for individuals with risk factors for BRVO. These examinations can help in early detection, even before the onset of symptoms, allowing for prompt intervention and better management of the condition.

Management and Treatment of Branch Retinal Vein Occlusion

Management and treatment of BRVO are tailored to the individual’s specific needs and the severity of the condition. The primary goals are to improve vision, treat any underlying conditions, and prevent further complications.

Observation

In mild cases where there’s minimal impact on vision, observation might be the initial approach. Regular monitoring allows for timely intervention if the condition worsens.

Laser Photocoagulation Therapy

For cases with macular oedema or retinal neovascularisation, laser therapy can be used to seal leaking blood vessels and reduce oedema.
This treatment can help stabilise vision and prevent further deterioration.

Intravitreal Injections

Anti-VEGF Therapy: Medications such as bevacizumab, ranibizumab, or aflibercept are injected into the eye. They work by inhibiting the Vascular Endothelial Growth Factor (VEGF), which plays a big role in the formation of abnormal blood vessels and leakage.
Corticosteroid Therapy: Steroids like triamcinolone acetonide or dexamethasone implants can be used to reduce inflammation and macular oedema.

Managing Underlying Health Conditions

Controlling systemic conditions like hypertension, diabetes, and hyperlipidemia is crucial in managing BRVO.
Collaborating with fellow healthcare professionals to enhance overall health and minimise the likelihood of additional occlusions may be necessary.

Lifestyle Modifications

Healthy lifestyle choices, such as maintaining a balanced diet, regular exercise, and smoking cessation, can positively impact overall vascular health and aid in the management of BRVO.

Regular Monitoring and Follow-up

Routine eye examinations are crucial for monitoring the condition of your eyes and making any necessary adjustments to treatment.
Periodically, Optical Coherence Tomography (OCT) and other imaging techniques can be employed to evaluate the treatment’s response. This enables a comprehensive assessment while ensuring precision and accuracy.

Complications of Branch Retinal Vein Occlusion

While timely and effective treatment of BRVO can significantly reduce the risk of complications, some individuals may experience long-term consequences:

Chronic Macular Oedema: Persistent swelling in the macula can lead to irreversible damage to the retinal cells, resulting in prolonged vision impairment.
Retinal Neovascularisation: In response to impaired blood flow and oxygen deprivation, the retina may develop new, abnormal blood vessels. These vessels are fragile and can lead to further complications.
Vitreous Haemorrhage: The new, abnormal blood vessels may bleed into the vitreous, the gel-like substance in the eye, causing sudden visual loss.
Neovascular Glaucoma: Abnormal blood vessels can grow on the iris and in the drainage angle of the eye, leading to a painful form of glaucoma with elevated intraocular pressure.
Retinal Detachment: Scar tissue from the neovascularisation can pull the retina away from its underlying support tissue, leading to a retinal detachment, a serious condition that can cause permanent vision loss if not treated promptly.
Permanent Vision Loss: Despite treatment, some individuals may experience permanent loss of vision, particularly if there is extensive damage to the macula or if treatment is delayed.

Prognosis of Branch Retinal Vein Occlusion

The prognosis for BRVO depends on several factors:

Severity and Location: The extent of the blockage and the area of the retina affected play a crucial role in determining the outcome. Occlusions affecting the macula tend to have a more significant impact on vision.
Timeliness of Treatment: Early diagnosis and treatment are key to improving the prognosis. The longer the retina remains swollen or ischemic (lacking blood flow), the higher the risk of permanent damage.
Underlying Health Conditions: The presence and management of systemic conditions like diabetes and hypertension can influence recovery. Better control of these conditions can lead to a more favourable outcome.
Response to Treatment: Individual responses to treatments like anti-VEGF therapy and laser photocoagulation can vary, influencing the overall prognosis.
Age and Overall Health: Generally, younger patients with fewer health issues may have a better prognosis compared to older individuals with multiple health concerns.

Lifestyle Modifications for Managing Branch Retinal Vein Occlusion

Lifestyle changes play a crucial role in the management of Branch Retinal Vein Occlusion (BRVO) and in reducing the risk of its complications. These modifications not only support the treatment plan but also improve overall health, which can positively impact the prognosis of BRVO.

Maintain a Healthy Diet

Nutrient-rich foods: Consume a diet rich in fruits, vegetables, whole grains, and lean proteins. These food items are rich in antioxidants and vital nutrients that promote the health of our eyes.
Omega-3 Fatty Acids: Foods like fish, flaxseeds, and walnuts, rich in omega-3 fatty acids, are known to support vascular health.
Reduce Salt Intake: Lowering salt intake can help manage high blood pressure, a significant risk factor for BRVO.

Regular Exercise

Aerobic Activities: Engaging in regular aerobic exercises such as walking, swimming, or cycling can improve cardiovascular health and blood circulation, which is beneficial for eye health.
Consultation with Healthcare Providers: Before starting any new exercise regimen, it’s important to consult with healthcare providers, especially for individuals with underlying health conditions.

Weight Management

Healthy Weight: Maintaining a healthy weight is of utmost importance in mitigating the risk of diabetes, hypertension, and hyperlipidemia. By managing weight effectively, individuals can mitigate the likelihood of developing these conditions, enhancing their overall well-being.
Regular Monitoring: Regular check-ups and monitoring of body mass index (BMI) can aid in effective weight management.

Quit Smoking

Avoid Tobacco: Smoking cessation is crucial as tobacco use can significantly increase the risk of vascular problems, including those affecting the eyes.
Seek Support: Utilising cessation programs and support groups can be helpful in quitting smoking.

Control Blood Sugar Levels

Diabetic Patients: For those with diabetes, maintaining optimal blood sugar levels is essential to prevent diabetic retinopathy, which can exacerbate BRVO.
Regular Monitoring: Regular blood sugar testing and adherence to diabetic medication can help in controlling blood sugar levels.

Limit Alcohol Consumption

Moderation: It is crucial to consume alcohol in moderation because excessive intake can negatively impact blood pressure and overall vascular health.

Manage Stress

Relaxation Techniques: Engaging in practices like yoga, meditation, and deep breathing exercises can effectively alleviate stress, which in turn can have an indirect positive influence on vascular health.
Balanced Lifestyle: Maintaining a balanced lifestyle, including adequate sleep and relaxation, is beneficial for overall well-being.

Regular Eye Examinations

Ongoing Monitoring: Regular eye exams are crucial, not only for monitoring the status of BRVO but also for the early detection of any new ocular conditions.

Frequently Asked Questions (FAQs) about Branch Retinal Vein Occlusion

Q1: What is Branch Retinal Vein Occlusion (BRVO)?

A1: BRVO is a blockage in the small veins of the retina, the layer at the back of the eye responsible for vision. This blockage can lead to vision loss due to the accumulation of fluid and blood in the retina.

Q2: What causes BRVO?

A2: The most common cause of BRVO is a blood clot in the retinal veins. Risk factors include hypertension, diabetes, glaucoma, age-related vascular changes, smoking, and certain blood disorders.

Q3: What are the symptoms of BRVO?

A3: Symptoms may include sudden blurring or loss of vision in one part of the field of vision, seeing floaters, or a blind spot. Some people may experience a general decrease in vision.

Q4: How is BRVO diagnosed?

A4: BRVO is diagnosed through a comprehensive eye examination, which may include a fundus examination, optical coherence tomography (OCT), fluorescein angiography, and visual acuity tests.

Q5: Can BRVO lead to permanent vision loss?

A5: If left untreated, BRVO can lead to complications like chronic macular oedema, which can cause permanent vision loss. Timely detection and treatment play a vital role in safeguarding our precious vision.

Q6: What are the treatment options for BRVO?

A6: Treatment options include laser photocoagulation, intravitreal injections of anti-VEGF medications or corticosteroids, and managing underlying health conditions. The treatment choice depends on the specific symptoms and severity of the case.

Q7: Can lifestyle changes affect BRVO?

A7: Yes, lifestyle changes such as maintaining a healthy diet, regular exercise, smoking cessation, and managing blood pressure and blood sugar levels can positively impact the management of BRVO.

Q8: Is BRVO preventable?

A8: While not all cases of BRVO can be prevented, managing risk factors like hypertension, diabetes, and high cholesterol can reduce the risk. Regular eye exams play a crucial role in detecting and preventing complications at an early stage.

Q9: How often should I have my eyes checked if I have BRVO?

A9: The frequency of eye exams depends on the severity of your condition. Your eye doctor will recommend a follow-up schedule, which may be more frequent initially and then annually or biannually, depending on your response to treatment.

Q10: Can BRVO occur in both eyes?

A10: BRVO typically occurs in one eye, but it is possible for it to affect both eyes, although this is less common. Regular monitoring is essential for detecting any changes in the unaffected eye.

Conclusion

BRVO is a complex condition that requires immediate or urgent treatment to prevent serious complications. With proper management, individuals with BRVO can maintain their quality of life and minimise the risk of severe vision loss.

Reach out to us today at (03) 9070 5753 to schedule an appointment with our team of experienced eye doctors. Ensure that your eyes receive the exceptional care they deserve. Ensuring the longevity of your vision hinges on early detection and timely treatment. Don’t delay; act now to safeguard your eyes and uphold optimal eye health.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

References

https://my.clevelandclinic.org/health/diseases/14206-retinal-vein-occlusion-rvo
https://www.ncbi.nlm.nih.gov/books/NBK535370/

crao vs crvo melbourne

CRAO vs CRVO: Unravelling the Intricacies of Retinal Occlusions

November 30, 2023/0 Comments/in Retinal Surgery /by Armadale Eye Clinic Team

The world of ophthalmology is both intriguing and complex. Among the various conditions that can threaten our vision, retinal occlusions stand out as particularly daunting. Within this category, Central Retinal Artery Occlusion (CRAO) and Central Retinal Vein Occlusion (CRVO) are two major culprits. Understanding the “CRAO vs CRVO” distinction is paramount for clinicians and patients. This blog aims to delineate the intricacies of these conditions.

Introduction to Retinal Occlusions

– Retinal Artery Occlusion (RAO): This occurs when there’s a blockage in the retinal artery. There are two types: Central Retinal Artery Occlusion (CRAO), where the main artery is blocked, and Branch Retinal Artery Occlusion (BRAO), where a branch of the retinal artery is affected.

– Retinal Vein Occlusion (RVO): This transpires when there’s an obstruction in the retinal vein. It can be a Central Retinal Vein Occlusion (CRVO), where the main vein is blocked, or a Branch Retinal Vein Occlusion (BRVO), where a branch of the retinal vein is obstructed.

Symptoms and Clinical Presentation

– CRAO:

– Sudden vision loss, often described as a “curtain coming down.”

– The affected eye may have poor central vision.

– Blurred vision or sudden onset of blindness.

– CRVO:

– Vision loss, but can vary from slight to severe.

– Blurred vision due to macular edema.

– Retinal hemorrhages are a common sign.

Risk Factors and Causes

Understanding the risk factors and causes of retinal occlusions is paramount, as this knowledge can inform prevention strategies and early intervention. Both CRAO and CRVO, while similar in their effect on vision, have slightly differing risk profiles. Let’s delve deeper into the underlying causes and common risk factors associated with each condition.

Central Retinal Artery Occlusion (CRAO) Risk Factors and Causes

Cardiovascular Disease: A leading contributor, cardiovascular diseases can cause blood clots or plaques that may travel to the eye and block the central retinal artery.
Giant Cell Arteritis: This inflammatory condition can cause swelling of the arteries, including the central retinal artery, leading to occlusion.
High Blood Pressure: Persistently high blood pressure can have harmful effects on blood vessels, including those within the eye.
Diabetes: The disease can result in a range of vascular complications, including conditions that make a person more susceptible to retinal artery occlusions.
Hypercoagulable States: Conditions that make the blood more prone to clotting can lead to obstructions in the retinal arteries.
Valvular Heart Disease: People with certain heart valve diseases might be at an increased risk due to the potential for clot formation.

Central Retinal Vein Occlusion (CRVO) Risk Factors and Causes

Age: Older individuals, particularly those over the age of 65, are at an increased risk of developing CRVO.
Glaucoma: Elevated intraocular pressure can compress the central retinal vein, leading to occlusion.
Vascular Diseases: Conditions like hypertension or atherosclerosis can affect the health and integrity of blood vessels, making vein occlusion more likely.
Blood Disorders: Conditions such as polycythemia vera or sickle cell disease can predispose individuals to vein occlusions.
Inflammatory Conditions: Diseases like Behçet’s disease or sarcoidosis can cause inflammation of the blood vessels, including the central retinal vein.
Oral Contraceptives: Some studies suggest a correlation between the use of oral contraceptives and an increased risk of CRVO.

Shared Risk Factors

While the aforementioned factors lean more towards one condition than the other, several risk factors are shared between CRAO and CRVO:

Age: As one advances in age, the likelihood of developing vascular issues increases.
Smoking: This habit significantly exacerbates the risk of blood vessel issues and, consequently, occlusions.
High Cholesterol: Elevated cholesterol levels can lead to arterial plaques and impact the health of veins.
Obesity: Excessive weight is associated with a range of cardiovascular issues, which, in turn, can increase the risk of retinal occlusions.
Chronic Kidney Disease: Impaired kidney function has been linked to a higher risk of both CRAO and CRVO.

Diagnosis

Diagnosing retinal occlusions accurately is essential for determining the best course of treatment. Both CRAO and CRVO have distinct clinical presentations, but they also share common diagnostic methods.

Diagnostic Methods for Central Retinal Artery Occlusion (CRAO)

Fundoscopic Examination: The most basic diagnostic tool. Upon examination, the ophthalmologist may observe a pale retina with a distinctive cherry-red spot at the fovea.
Fluorescein Angiography: This involves injecting a dye into the bloodstream and then photographing the retina. In CRAO, there’ll be a delay or absence of arterial filling and slow venous return.
Optical Coherence Tomography (OCT): A non-invasive imaging test that uses light waves to take cross-sectional images of the retina. It can detect retinal thickening or thinning, which can be indicative of CRAO.
Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP): If giant cell arteritis is suspected as an underlying cause, these blood tests can be used to confirm inflammation.
Carotid Ultrasound: To check for carotid artery stenosis or plaque, which could be a source of emboli leading to CRAO.
Echocardiography: Used to detect potential sources of emboli in the heart.

Diagnostic Methods for Central Retinal Vein Occlusion (CRVO)

Fundoscopic Examination: Characteristic findings include retinal haemorrhages, venous dilation, tortuosity, and possibly macular edema.
Fluorescein Angiography: Useful in differentiating between ischemic and non-ischemic types of CRVO by identifying areas of non-perfusion.
Optical Coherence Tomography (OCT): Particularly useful in detecting and quantifying macular oedema, a frequent complication of CRVO.
Intraocular Pressure Measurement: Elevated eye pressure can be both a risk factor for and a complication of CRVO.
Blood Tests: To check for associated systemic conditions like diabetes, hypercoagulable states, or hypertension.

Shared Diagnostic Methods

For both CRAO and CRVO, the following are generally recommended:

Visual Acuity Test: Measures the sharpness of vision. A sudden drop in visual acuity can be indicative of either condition.
Visual Field Testing: Helps in assessing the extent of vision loss and pinpointing areas of the visual field that are affected.
Tonometry: Measures the intraocular pressure. Elevated intraocular pressure can be a risk factor for CRVO and can also occur as a secondary complication in both conditions.

Treatment Modalities

The treatment for retinal occlusions depends on the type of occlusion (CRAO or CRVO), its cause, and the extent of the damage. Both conditions mandate prompt medical attention to optimise outcomes and minimise lasting vision impairment.

Treatment for Central Retinal Artery Occlusion (CRAO)

Ocular Massage: An initial intervention where the doctor may perform a gentle massage on the affected eye. This might help dislodge the clot obstructing the retinal artery.
Lowering Intraocular Pressure: Medications like acetazolamide or mannitol can be administered to reduce eye pressure, which may help increase blood flow to the retina.
Hyperbaric Oxygen Therapy: Breathing in oxygen under increased pressure can enhance the amount of oxygen reaching the retina, possibly helping in retinal recovery.
Anterior Chamber Paracentesis: A procedure in which a small amount of fluid is removed from the front part of the eye to rapidly decrease intraocular pressure.
Vasodilators: Drugs like nifedipine can help in dilating the blood vessels to improve blood flow.
Treatment for Underlying Causes: For instance, if giant cell arteritis is suspected, immediate high-dose corticosteroids are essential.
Preventative Measures: As CRAO can be a sign of cardiovascular disease, it’s crucial to address underlying cardiovascular risk factors like high blood pressure, diabetes, and cholesterol.

Treatment for Central Retinal Vein Occlusion (CRVO)

Intravitreal Injections: Medications, particularly anti-vascular endothelial growth factor (VEGF) agents or steroids, can be injected directly into the eye to reduce macular oedema and improve vision.
Laser Therapy: Focal laser treatment can help reduce macular oedema by sealing off leaking blood vessels. In cases with severe retinal ischemia, panretinal photocoagulation might be used to prevent or treat abnormal blood vessel growth and its complications.
Surgical Procedures: Procedures like vitrectomy can be employed, especially when there are vitreous haemorrhages.
Managing Underlying Conditions: Just as with CRAO, addressing systemic conditions like diabetes and hypertension is pivotal.
Observation: In some cases of non-ischemic CRVO, observation with regular follow-ups might be recommended, as the condition can self-resolve or stabilise.

Shared Treatment Modalities

Both CRAO and CRVO share some common grounds in treatment:

Blood-thinning Medications: Medications like aspirin or warfarin may be prescribed to reduce the risk of future clots.
Lifestyle Changes: Adopting a healthy lifestyle by managing weight, avoiding smoking, and controlling blood sugar and blood pressure can be beneficial in both conditions.
Close Monitoring: Regular follow-ups with comprehensive eye exams are crucial for tracking the progression and making timely treatment decisions.

Outcomes and Prognosis

The prognostic implications of retinal occlusions, be it CRAO or CRVO, largely depend on the severity of the occlusion, its etiology, the timeliness of interventions, and associated complications. As both conditions involve critical blood vessels that nourish the retina, their impact on visual function can be substantial.

Outcomes for Central Retinal Artery Occlusion (CRAO)

Visual Acuity: The sudden onset of vision loss in CRAO often results in poor visual outcomes. While some spontaneous improvement can occur within the first few days, permanent vision loss is common if not treated within the critical first hours.
Subsequent Risks: CRAO is frequently considered an “eye stroke,” and its occurrence could be an indicator of broader systemic health issues, notably cardiovascular disease. Patients with CRAO have an elevated risk of stroke, myocardial infarction, and other vascular events.
Complications: Prolonged retinal ischemia due to CRAO can lead to complications like neovascular glaucoma, a severe form of glaucoma that can result in profound vision loss and pain.

Outcomes for Central Retinal Vein Occlusion (CRVO)

Ischemic vs. Non-Ischemic CRVO: The prognosis differs significantly between these two types. Non-ischemic CRVO generally has a better visual prognosis, with a chance of spontaneous improvement. However, it can sometimes transition into the ischemic variant. Ischemic CRVO is more severe, with a poorer visual outcome and a higher risk of complications.
Macular Edema: This is a common complication of CRVO and can be a persistent issue affecting vision. However, with treatments like anti-VEGF injections and laser therapy, many patients experience improvement.
Neovascularisation: Due to extensive retinal ischemia, new, abnormal blood vessels can grow on the retina or iris. These vessels can cause complications such as vitreous haemorrhage or neovascular glaucoma, which can further compromise vision.

General Prognostic Factors

Duration of Occlusion: The longer the retina is deprived of blood, the worse the visual outcome. Immediate treatment can sometimes help salvage vision.
Underlying Causes: Addressing and managing systemic conditions, such as high blood pressure, diabetes, or blood clotting disorders, can influence outcomes.
Extent of Occlusion: Partial or branch occlusions generally have a better prognosis than complete or central occlusions.
Age and General Health: Younger patients and those without significant systemic health issues might have a slightly better prognosis.

Prevention and Risk Reduction

Given the potentially severe consequences of CRAO and CRVO, an emphasis on prevention and risk factor management is paramount. While not all cases are preventable, several strategies can be employed to reduce the risk of these conditions.

Manage Cardiovascular Risk Factors

Blood Pressure Control: Hypertension is a significant risk factor. Regular check-ups, adhering to prescribed medications, and lifestyle changes such as reduced salt intake can help in managing blood pressure levels.
Diabetes Management: Keeping blood sugar levels within the recommended range is crucial. Regular monitoring, medication adherence, and dietary modifications are vital aspects of diabetes care.
Lipid Profile Management: Elevated cholesterol and triglyceride levels can contribute to vascular diseases. Regular screenings and appropriate medical treatments, alongside a balanced diet, can be beneficial.
Smoking Cessation: Smoking is a known risk factor for numerous cardiovascular diseases. Quitting smoking can significantly reduce the risk of retinal occlusions and other vascular conditions.

Regular Eye Check-ups

Early Detection: Regular comprehensive eye exams can help in the early identification of changes in the retina, allowing for timely interventions and management.
Monitoring Retinal Veins and Arteries: Those with a history of minor retinal artery or vein occlusions should be closely monitored for potential progression or recurrence.

Lifestyle Measures

Diet: A heart-healthy diet rich in fruits, vegetables, whole grains, and lean protein can contribute to vascular health and reduce the risk of clot formation.
Exercise: Regular physical activity promotes cardiovascular health, aiding in blood circulation and reducing the risk of clotting.
Weight Management: Maintaining a healthy weight can significantly reduce the risk of hypertension, diabetes, and other cardiovascular diseases.

Medications and Therapies

Blood Thinners: For those at high risk, anticoagulant or antiplatelet medications might be prescribed to prevent clot formation.
Regular Medication Reviews: Periodic reviews of one’s medication list with a doctor can help in identifying drugs that might increase the risk of clotting.
Stress Management: Chronic stress can contribute to vascular complications. Techniques such as meditation, deep breathing exercises, and regular relaxation can be useful.

Education and Awareness

Recognise Symptoms: Being aware of the symptoms of CRAO and CRVO can lead to quicker medical attention, potentially reducing the severity of outcomes.
Understand the Risks: Those with a family or personal history of vascular events or conditions like cardiac valvular disease need to be particularly vigilant.

Conclusion and Parting Thoughts

Understanding the nuances of “CRAO vs CRVO” is more than just grasping medical terminology. It’s about recognising the profound impact such conditions can have on a person’s life. Whether it’s the sudden vision loss from a CRAO or the gradual degradation from a CRVO, the effects are life-altering.

By being informed, one can take proactive measures – from regular comprehensive eye exams to addressing risk factors like high blood pressure. Additionally, should symptoms like sudden vision loss or blurred vision occur, understanding their potential severity can hasten medical treatment – a pivotal factor in outcomes.

Contact us at (03) 9070 5753 if you have any more questions or concerns about CRAO vs CRVO and how to stay vigilant about your vision health. We are here to help.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

References

https://my.clevelandclinic.org/health/diseases/14206-retinal-vein-occlusion-rvo
https://www.hopkinsmedicine.org/health/conditions-and-diseases/central-retinal-artery-occlusion#:~:text=Central%20retinal%20artery%20occlusion%20is%20the%20blockage%20of%20blood%20to,thicker%20and%20stickier%20than%20normal.

retinal detachment symptoms melbourne

Retinal Detachment Symptoms — How to Identify Them?

February 13, 2023/0 Comments/in Armadale Eye Blogs /by armadaleeye

The retina is a delicate layer of tissue lining the inside of the eyeball at the back. Its function is to detect incoming light, convert the light into neural signals, and forward these signals to the visual processing centres of the brain. It’s a complex piece of anatomy and crucial for vision. This part of the eye can also be subject to a number of retinal eye conditions, many of which can result in permanent sight impairment.

One of these is an ocular emergency known as retinal detachment. Being able to recognise early retinal detachment symptoms is essential to improving the prognosis of your sight. Keep reading to find out what you need to know about retinal detachment.

What is a Retinal Detachment?

As the name suggests, a retinal detachment occurs when the retinal tissue comes away from the wall of the eyeball. Many eyecare practitioners will describe this as wallpaper peeling away from the wall. The retina relies on oxygen, nutrients, and other metabolic support from the underlying tissues of the eye, such as the choroid layer. In addition to no longer being able to receive this crucial support, a retinal detachment also means the retinal cells are unable to transmit their neural signals onward through the visual pathway.

A retinal detachment is one of those retinal eye conditions that constitute an emergency. The success of retinal detachment surgery and restoration of sight depends, in part, on how long the retina has been detached for. This is why being able to recognise when you’re experiencing retinal detachment symptoms is important for seeking urgent medical attention.

What are the Retinal Detachment Symptoms?

Retinal detachment symptoms can vary. Not everyone will experience all the symptoms, and in fact, some patients may have an asymptomatic retinal detachment that’s only incidentally detected on a routine eye check-up. However, more often than not, you will notice that something is unusual if you are experiencing detachment.

These are the common symptoms of retinal detachment:

Flashing lights. The medical term for this is photopsia. You may see what looks like a lightning flash out of the corner of your eye, or it may feel like the sudden flash of a reflection from a surface. Many people report this as being the most apparent when they move their eyes or shake their heads, and it may be more noticeable when the environment is dark. Photopsia during a retinal detachment occurs because as the retina is pulling away from the wall of the eyeball, it mechanically stimulates the neurons to fire, inducing the perception of light.
Floaters. Floaters are dark or translucent specks, lines, squiggles, or cobwebs-like shapes that you see in your vision. Sometimes people may think they’re seeing actual spiderwebs or a cloud of flies in front of them. During a retinal detachment, floaters can arise from blood released from broken retinal blood vessels or from fragments of retinal tissue floating around the vitreous gel inside the eyeball. The onset of floaters can also be a sign of one of the retinal eye conditions that are a normal part of ageing, known as a posterior vitreous detachment. However, you can’t know for certain whether you’re experiencing a retinal detachment or a posterior vitreous detachment until you have an examination with an eye care professional.
Blurred sight. As the retina comes away, it is no longer able to perform its job in enabling sight. This means in the area of detachment, you may realise you can’t see as clearly. This will be especially noticeable if your macula is involved in the detachment, as this part of the retina is responsible for your central vision, which we’re most attentive to.
Dark, missing areas of your visual field. During a retinal detachment, you may feel like a dark curtain or shadow is coming across your field of sight. This represents the area of the retinal detachment where the retinal tissue is no longer able to perceive light.

A detached retina will most likely need retinal detachment surgery by a retinal specialist.

What to Do if You Think You’re Having a Retinal Detachment?

If you experience any of the symptoms of a retinal detachment, it’s important to see an eye care professional on the same day. GPs don’t have the necessary equipment to investigate a retinal detachment and will have to refer you to an eye care professional.

You can contact your local optometrist, who can discuss your symptoms with you. If they think the likelihood of a retinal detachment is high, they may suggest you go straight to your city’s eye and ear hospital or a hospital emergency department. Depending on your optometrist and their experience, they may alternatively recommend you come in to see them for an examination to see whether you need a referral for retinal detachment surgery.

If you are already under the care of an ophthalmologist, you can contact their rooms for advice. Only an ophthalmologist is able to perform retinal detachment surgery, typically one who has undergone specialist training in managing retinal conditions.

When you attend an eyecare appointment to investigate a retinal detachment, you should avoid driving. This is because your eyecare practitioner will need to perform a dilated eye exam to thoroughly assess the retina. You will have eyedrops instilled that will widen the pupil. The effect of a dilated pupil is that your clinician can see further out to the periphery of the retina, but it also means you will be quite glare-sensitive, and it may be difficult to see clearly for the duration of the eye drops. For most people, the eyedrops wear off after about an hour or two. For this period of time, your near sight may also be quite blurred.

Call us on (03) 9070 5753 today.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

References

Retinal detachment.
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/retinal-detachment#long-term-outlook-for-retinal-detachment

Asymptomatic Rhegmatogenous Retinal Detachments.
https://www.ophthalmologyretina.org/article/S2468-6530(22)00474-2/fulltext