Vessel Problems (BRAO, CRAO, BRVO, CRVO, CSR)

Branch Retinal Artery Occlusion (BRAO)

Most people know that high blood pressure and other vascular diseases pose risks to overall health, but many may not know that high blood pressure can affect vision by damaging the arteries in the eye.

Branch retinal artery occlusion (BRAO) blocks the small arteries in the retina, the light-sensing nerve layer lining the back of the eye. The most common cause of BRAO is a thrombosis, the formation of a blood clot. Sometimes the blockage is caused by an embolus, a clot carried by the blood from another part of the body.
Central vision is lost suddenly if the blocked retinal artery is one that nourishes the macula, the part of the retina responsible for fine, sharp vision. Following BRAO, vision can range from normal (20/20) to being barely able to detect hand movement.

BRAO poses significant risks to vision. If you have had a branch retinal artery occlusion, regular visits to your ophthalmologist are essential.

BRAO:
                    



(whitening in the retina where non-perfusion or ischemia occurred)

Central Retinal Artery Occlusion (CRAO)

You probably know that high blood pressure and other vascular diseases pose risks to your overall health, but you may not know that they can affect your eyesight by damaging the arteries in your eye.

Central retinal artery occlusion (CRAO)
usually occurs in people between the ages of 50 and 70. The most common medical problem associated with CRAO is arteriosclerosis (hardening of the arteries). Carotid artery disease is found in almost half the people with CRAO.

The most common cause of CRAO is a thrombosis (an abnormal blood clot formation). CRAO can also be caused by an embolus, a clot that breaks off from another area of the body and is carried to the retina by the bloodstream.

CRAO blocks the central artery in your retina, the light-sensitive nerve layer at the back of the eye. The first sign of CRAO is a sudden and painless loss of vision that leaves you barely able to count fingers or determine light from dark.

Loss of vision can be permanent without immediate treatment. Irreversible retinal damage occurs after 90 minutes, but even 24 hours after symptoms begin, vision can still be saved. The goal of emergency treatment is to restore retinal blood flow. After emergency treatment, you should have a thorough medical evaluation.

CRAO:               



(diffuse whitening of the retina from non-perfusion with a cherry red central spot)


Branch Retinal Vein Occlusion (BRVO)

Most people know that high blood pressure and other vascular diseases pose risks to overall health, but many may not know that high blood pressure can affect vision by damaging the veins in the eye. High blood pressure is the most common condition associated with branch retinal vein occlusion (BRVO). About 10% to 12% of the people who have BRVO also have glaucoma (high pressure in the eye).

BRVO blocks small veins in the retina, the layer of light-sensing cells at the back of the eye. If the blocked retinal veins are ones that nourish the macula, the part of the retina responsible for straight-ahead vision, some central vision is lost. During the course of vein occlusion, 60% or more will have swelling of the central macular area. In about one-third of people, this macular edema will last for more than one year.

BRVO causes a painless decrease in vision, resulting in misty or distorted vision. If the veins cover a large area, new abnormal vessels may grow on the retinal surface, which can bleed into the eye and cause blurred vision.

There is no cure for BRVO. Finding out what caused the blockage is the first step in treatment. Dr. Haas may recommend a period of observation, since hemorrhages and excess fluid may subside on their own. Depending on how damaged the veins are, laser surgery may help reduce the swelling and improve vision. Laser surgery may also shrink abnormal new blood vessels that can grow and that are at risk of bleeding. Newer, injectable medicines (anti-VEGF and steroids) are being investigated for treating BRVO as well.

BRVO:                        

      

Central Retinal Vein Occlusion (CRVO)

You probably know that high blood pressure and other vascular diseases pose risks to overall health, but you may not know that they can affect eyesight by damaging the veins in the eye.

Central retinal vein occlusion (CRVO)
blocks the main vein in the retina, the light-sensitive nerve layer at the back of the eye. The blockage causes the walls of the vein to leak blood and excess fluid into the retina. When this fluid collects in the macula (the area of the retina responsible for central vision), vision becomes blurry.
Floaters in your vision are another symptom of CRVO. When retinal blood vessels are not working properly, the retina grows new fragile vessels that can bleed into the vitreous, the fluid that fills the center of the eye. Blood in the vitreous clumps and is seen as tiny dark spots, or floaters, in the field of vision.

In severe cases of CRVO, the blocked vein causes painful pressure in the eye. Retinal vein occlusions commonly occur with glaucoma, diabetes, age-related vascular disease, high blood pressure, and blood disorders.

The first step of treatment is finding what is causing the vein blockage. There is no cure for CRVO. Dr. Haas may recommend a period of observation, since hemorrhages and excess fluid often subside on their own. Laser surgery may be effective in preventing further bleeding into the vitreous or for treating glaucoma, but it cannot remove a hemorrhage or cure glaucoma once it is present. Newer, injectable medicines (anti-VEGF and steroids) are being investigated for treating CRVO as well.

CRVO:                       

       

Central Serous Retinopathy (CSR)

Central serous retinopathy (CSR) is a small, shallow swelling that develops on the retina, the light-sensitive nerve layer that lines the back of the eye. Although the swelling reduces or distorts vision, the effects are usually temporary. Vision generally recovers on its own within a few months.

In the initial stages of CSR, vision may suddenly become blurred and dim. If the macula (the area of the retina responsible for central vision) is not affected, there may be no obvious symptoms.

CSR typically affects adults between the ages of 20 and 50. People with CSR often find that their retinal swelling resolves without treatment and their original vision returns within six months of the onset of symptoms. Some people with frequent episodes may have some permanent vision loss. Recurrences are common and can affect 20% to 50% of people with CSR. While the cause of CSR is unknown, it seems to occur at times of personal or work-related stress.

As CSR usually resolves on its own, no treatment may be necessary. Sometimes laser surgery can reduce the swelling sooner, but the final visual outcome is usually about the same. If retinal swelling persists for more than three or four months, or if an examination reveals early retinal degeneration, laser surgery may be helpful.

OCT of CSR (demonstrating swelling):         
 

Normal OCT (no swelling):  

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