EYE STROKE - Retinal Vein Occlusion (Causes, Symptoms, Treatment)
EYE STROKE - Retinal Vein Occlusion (Causes, Symptoms, Treatment)
Ever heard of an eye stroke? A Retinal vein occlusion can be classified as a branch retinal vein occlusion, a central retinal vein occlusion or a hemi central retinal vein occlusion. These “eye strokes” often cause severe vision loss due to macular edema (a swelling of the retina) or secondary glaucoma.
This was a topic that many viewers have asked about and I hope you enjoyed the longer content. Please let me know what eye health topic you would love to see me cover next!
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Joseph J. Allen, OD FAAO
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Retinal vein occlusions are major eye diseases that are heavily studied in ophthalmology and optometry. If you have any further questions or comments about BRVO or CRVO, please leave them in the comments!
MAIN MESSAGE from this video:
Taking care of yourself and striving for a healthy lifestyle will reduce your chances of having a retinal vein occlusion.
- Eat well
- Exercise more
- Manage your blood pressure \u0026 cholesterol
- Don’t smoke
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About this video: Ever heard of having an eye stroke? In this video, Dr. Allen from Doctor Eye Health reviews a common retinal condition and cause of blindness called a retinal vein occlusion. Specifically, this video goes over central retinal vein occlusion treatment and branch retinal vein occlusion treatment. If you are looking for an in depth retinal vein occlusion lecture, this might be it!
Content
0 -> so have you ever heard of somebody having a stroke
within their eye and in care we call them retinal
4.96 -> vein occlusions and in this video i'm gonna break
down the pathogenesis of how it affects the eye
10 -> ultimately our vision and then the treatments
for it that's today's video let's take a look.
22.8 -> hello and welcome this is dr Allen here from the
dr eye health show helping you learn all about the
26.56 -> eyes and vision if you're new here to the channel
definitely consider hitting that subscribe button
30.56 -> down below so you don't miss any of my future
videos about eye care topics such as this one
35.84 -> in fact this is a huge shout out to many of the
viewers who have requested this video specifically
40.48 -> for almost a full year and i apologize it took
me this long to get to it but here it goes first
46.16 -> of all retinal vein occlusions are a pretty
big topic in eye care both in optometry and
51.28 -> ophthalmology this is something we all have to
learn and really know very well because it can
56.16 -> be a serious cause of vision loss and potentially
other complications and issues within the eye
61.76 -> and oftentimes doctors will try to easily explain
to their patients what's going on by just saying
65.92 -> that they had a stroke within their eye now
there could be many things in the eye that could
70.88 -> be described as having a stroke this happens
to be a vein occlusion or one of the veins in
76.72 -> the eye becomes occluded and then you have all
these problems there's also artery occlusions
81.84 -> completely different thing we're gonna save that
for another video sometime in the future but when
86.08 -> we talk about vein occlusions there's generally
three types in eye care there's a central retinal
91.28 -> vein occlusion a hemicentral retinal vein
occlusion and a branch retinal vein occlusion
96.32 -> you see the retina in the back of the eye is
known to have a dual blood supply this means it
100.8 -> has arteries and veins that go through the optic
nerve and into the eye and supply blood and oxygen
107.68 -> and nutrients to the front surface of the retina
but then it also has another set of blood vessels
112.96 -> on the back of the eye through what is called the
choroid now the veins that i'm talking about in
117.2 -> this condition these are the blood vessels within
the retina that go through the optic nerve and
121.76 -> actually supply the anterior portion of the retina
now depending on the location of the occlusion
128.32 -> it could be in the central retinal vein
this is right where the blood vessels first
132.72 -> enter and exit the optic nerve going in and out of
the eye then there's the hemi central retinal vein
139.36 -> occlusion which is a little bit more anterior to
that but then you have a full branch retinal vein
144 -> occlusion this occurs more within the retina and
has a very distinct look to it when someone has
149.12 -> a central retinal vein occlusion such as this
the doctor will see a lot of blood throughout
153.84 -> the entire retina it affects all of the areas of
the retina and oftentimes in school we learned to
159.2 -> recognize this as blood and thunder where somebody
with a branch retinal vein occlusion this is where
164.72 -> the retinal vein that has a branch to it inside
the eye that one is selectively occluded and
172 -> then it's just kind of a whole arm or section
of that vein that's been blocked off such as in
176.8 -> this picture here where you can see the blood just
kind of pooling in the retina just in one specific
182.16 -> quadrant i think by far in my practice i see
branch retinal vein occlusions much more often and
187.28 -> central retinal vein occlusions coming just kind
of close second but thankfully the pathogenesis
192.16 -> for all these conditions are very similar and
i'll kind of want to break these down just so
196.32 -> that you understand what's happening within
the eye now just for simplicity's sake let's go
200.56 -> over branch retinal vein occlusions first we call
them brvo 's in the clinic and i like to describe
206 -> brvo's first to like students first because
the brvo are a little bit simpler to understand
211.76 -> and the same pathogenesis that is affecting the
branch retinal vein occlusion it can also be
215.76 -> applied to all other forms of vein occlusions now
within the eye the central retinal artery and vein
220.88 -> they travel through the optic nerve and then they
spread out into different quadrants of the eye you
224.96 -> have the superior temporal quadrant the superior
nasal quadrant you have the inferior temporal
229.68 -> quadrant and the inferior nasal quadrant now when
these blood vessels go out this direction they
235.2 -> both the artery in the vein they travel together
and the artery crosses over on top of the vein
241.76 -> this is important to remember think of it like
the different hoses that maybe you left out
246.64 -> for watering your lawn one summer the arteries
are going to cross over on top of the vein and
252.16 -> what happens is that with age different lifestyle
factors like inactivity people who don't exercise
258.08 -> and they have increased blood pressure people who
eat really poorly who eat a lot of greasy burgers
263.12 -> and pizza as well as people who smoke they're
at increased risk of developing what is called
268.48 -> arterial and arthrosclerosis arteriosclerosis
is where the blood vessel that artery itself
276.16 -> the walls of it become thicker and more rigid and
then atherosclerosis is where the cholesterol and
282.32 -> fatty plaques of your diet end up sticking on the
inner lining of your blood vessels and this ends
288.16 -> up collecting and ultimately can become a plaque
that blocks up the artery and that's what we call
294.32 -> a stroke and eventually a heart attack so all
these different things kind of accumulate and
298.88 -> cause the artery which is again is running over
on top of the vein to kind of swell up become
305.04 -> more rigid and thick and they share what is called
an adventitial sheath that's where the artery and
311.28 -> vein cross over each other they share the same
tissue and because the artery is getting thick
315.36 -> it starts to push on that vein causing the vein
the amount of space for the blood to flow through
321.36 -> gets smaller and smaller and with that you
create more turbulent blood flow within the vein
328.32 -> which that turbulence causes damage to the inner
lining of the vein and we that inner line called
334.8 -> the endothelium because it gets damaged the body
tries to repair it and with the repairing process
340.48 -> the new tissue the new endothelium isn't quite
the same and ultimately with sustained increased
346.48 -> blood pressure and continued damage eventually it
ruptures and that's when the blood breaks through
353.04 -> the vein and just spreads throughout the back of
the eye now most commonly a branch rental vein
358 -> occlusion we will see in the superior temporal
quadrant because there's more criss-crossing of
362.8 -> arteries and veins in that quadrant thankfully
if you're young under the age of 50 your risk
367.12 -> of having one of these conditions is much lower
there's still a possibility especially if you
371.6 -> have a hypercoagulability issue such as factor
five Leiden that maybe runs in your family or
377.6 -> maybe you take some sort of birth control like if
you're a woman you're taking birth control that
382.24 -> also carries a small risk of having a higher
chance of one of these especially when you're
385.76 -> young and when an eye doctor sees this whether
they're an optometrist or ophthalmologist they're
389.52 -> going to recognize whoa they have all this
blood in the back of the eye they have a brvo
394.08 -> okay we have to think do they have perfusion do
they have blood flowing to the retinal tissue
400.24 -> or not oftentimes in the clinic we can recognize
white spots on the retina that we call cotton wool
406.16 -> spots that's often an indication that there is
not perfusion and we call that ischemic branch
412.48 -> retinal vein occlusions or your doctor may order
what is called a fluorescein angiogram which
418 -> is where they put a flourishing sodium dye through
your arteries and veins and they take pictures of
422.8 -> the back of the eye and they can literally see
where blood is still flowing within the retinal
427.92 -> tissues and in a brvo you can have the ischemic
and non-ischemic versions the less blood flow or
434.64 -> more ischemic versions of a vein occlusion the
worse the vision and the consequences within
440.48 -> the eye are going to be so people can have milder
non-ischemic branch retinal vein occlusions that
445.92 -> they may not even notice that they have any vision
changes or any sort of problems in the eye at all
451.12 -> or they can have very ischemic vein occlusions
which ultimately lead to blank spots in their
456 -> vision and even blurred vision now ultimately what
happens because of these retinal vein occlusions
461.44 -> how it affects your vision is that the retina
itself is getting starved of oxygen and these
466.48 -> nutrients and so the retina starts to release
these inflammatory proteins these inflammatory
473.76 -> mediators are going to cause the blood vessels
around this kind of ischemic area that's not
479.84 -> getting its proper nutrients to it's gonna
allow these blood vessels to start leaking
484.56 -> and with this increased leakage and perfusion
of fluid from the blood vessels it's gonna cause
490.56 -> swelling this increased amount of fluid which
is supposed to essentially kind of heal the eye
495.68 -> ends up causing kind of a blister formation within
the retina and we call that macular edema and with
502.4 -> that it changes the architecture of the retina
and you lose a lot of your eyesight your vision
507.52 -> becomes extremely blurry so if this doesn't happen
if it's just a mild vein occlusion you may not
514.56 -> notice any difference in your visual acuity and
that's why it's really important to still see your
518.96 -> eye doctor every year because they can often see
that this happened maybe in the past maybe there's
523.76 -> some sort of indication that you had this a long
time ago or perhaps they're catching one live
528.88 -> going on right now i remember a time during my
residency i had a gentleman coming in just for a
533.52 -> pressure check for his glaucoma and i still looked
inside of his eye to look at the optic nerve and
537.92 -> i could see he was having a vein occlusion right
that moment so in that case i immediately said hey
542.64 -> sir you're having another issue that's unrelated
to your glaucoma your visit's going to last a
546.48 -> little bit longer we went and checked his blood
pressure and his blood pressure was alarmingly
550.8 -> high and that really takes me on to the treatment
for something like a branch retinal main occlusion
555.44 -> now my job is to first recognize diagnose what is
going on and also figure out if there is swelling
562.08 -> of the retina and ultimately guide kind of
treatment and management for this disease
567.28 -> one of the big issues again like this gentleman
that was in this story when i was at the VA
571.6 -> he had really high blood pressure so being that
so much of this disease has to do with your blood
578 -> pressure your cholesterol potentially if you have
diabetes other things like that it's important
583.04 -> that i manage and get this patient to be seen by a
primary care physician their general practitioner
590.4 -> order appropriate blood work so that we
know what's going on what are the risks
594.88 -> for potential stroke heart attack because that's
life-threatening so in this particular case after
599.68 -> we knew that gentleman had high elevated blood
pressure that day we also made a direct referral
604.56 -> to get blood work and then go see his family
doctor so that he could get his blood pressure
608.32 -> under control now thankfully that gentleman that
day still had 20 20 despite having a branch of
614.24 -> vein occlusion because his macula wasn't swollen
at all he had essentially a non-ischemic branch
620.08 -> retinal vein occlusion but that gentleman we still
had to watch him for several months because it's
625.84 -> possible it could have gotten worse he could
have had macular edema that developed if you are
630.72 -> somebody whoever does develop vision changes from
a vein occlusion such as a brvo when you have that
638.16 -> swelling you are going to be referred to a retinal
specialist with a retinal specialist they will
644.4 -> again do that fluorescein angiogram so they know
where the perfusion and non-perfusion is and then
648.96 -> they will offer different treatments most commonly
today the first line of treatment are injections
655.04 -> of a medication known as the anti-VEGF which
stands for vaso endothelial growth factor
662.16 -> and that's one of the special growth factors
that's released from the retinal tissue when
667.12 -> there is inflammation and not enough kind of not
enough nutrients and going to the retina itself
672.64 -> now i don't mean to scare people when i say you're
gonna get an injection a needle going into the eye
676.96 -> but thankfully these treatments work amazing and
oftentimes with repeated treatments and you're
682.32 -> close watching from your doctors they can get
things under control and most people do have a
687.52 -> good visual prognosis after a vein occlusion like
this most people do have vision better than 20/40
693.68 -> even if no treatment is given but even better
when there is treatment and alongside the possible
698.96 -> injections for treatment for this sort of macular
edema from a vein occlusion your doctor could
704.08 -> also recommend either laser or an injection of a
steroid inside of the eye these have been kind of
711.12 -> older technologies and treatments that we've used
however they can still be used in conjunction
716.16 -> with the anti-vegf injection again something that
you'll have to leave open to discussion with your
722.16 -> retinal specialist and believe me they know what
they're doing so if i was having this i would
726.96 -> just trust everything they say now in general
these different treatments that i just described
731.2 -> those are the same treatments that we use for
all forms of retinal vein occlusions the central
736.32 -> retinal hemi retinal vein occlusion it all happens
for the same pathogenesis as the branch retinal
740.4 -> vein occlusion except it's at different locations
within the eye however the central retinal vein
745.84 -> occlusion is a little bit more dramatic and has
a higher risk of other complications one of those
752.48 -> big issues is a certain type of glaucoma that
i want to kind of go over just a second what a
757.2 -> central vein occlusion is so i can better explain
what might be going on with that type of glaucoma
761.52 -> now again the central retinal vein it's the
central vein and so when that gets blocked off
766.32 -> the entire back of the eye looks completely filled
with blood again blood and thunder is what we call
771.44 -> it in school that's what they train us to see and
oftentimes this does come along with some sort
777.44 -> of uh macular edema so oftentimes when the doctor
when your eye doctor sees this they're gonna
782.8 -> send you to a retinal specialist right away but
it's also important for them to consider doing
787.36 -> a certain technique called gonioscopy this is a
special type of contact lens that's placed onto
793.36 -> the eye after the eye's been numbed with some sort
of eyedrop medication and then your doctor is able
799.68 -> to look through this special type of contact lens
because it's got mirrors on it and allows us to
804.48 -> look at the angle structure of where the aqueous
humor which is the fluid inside the eye that
811.04 -> controls the eye pressure we can see where the
air that aqueous humor is draining out of the eye
817.12 -> this angle which is formed by the iris and then
the cornea they come together at a certain spot
822.4 -> and that's where the fluid drains out of now what
happens is because a central vein occlusion is so
829.28 -> dramatic there's really really no nutrient getting
to the retina it's being starved very quickly
835.84 -> so new blood vessels start to grow inside
the eye these new blood vessels which we call
841.2 -> neovascularization these new blood vessels can
grow within the angle within that drain and that
847.84 -> means that there's nowhere for that aqueous humor
fluid to go so the eye pressure starts to go up
853.52 -> really high and this can be a very serious form
of glaucoma because that increased eye pressure
860.64 -> can push on the optic nerve and it can kill the
nerve and once the nerve is dead bye-bye vision
866 -> and in eye care we call that 90-day glaucoma
because within the first one to three months
871.92 -> that's when per a person's most at risk
of developing this glaucoma from a central
876.8 -> retinal vein occlusion now the ultimate
takeaway i hope you get from this video
880.56 -> is not just understanding the pathogenesis of
retinal vein occlusion and its treatments but to
886.72 -> take advocacy for your own health if you're having
vision changes make sure you see your eye doctor
892.24 -> and based on their recommendations follow whether
they want you back in a month if they prescribe
898.16 -> you treatment make sure you follow that treatment
they want what's best for you and your vision
902.64 -> and then second of all be an advocate for your
health in regards to your blood pressure your diet
909.2 -> and your lifestyle in general if you're somebody
who is already getting in your older age you're
914.64 -> over the age of 50 maybe you have not eaten a very
well in your life if you eat a lot of greasy foods
919.76 -> cheeseburgers pizza and things like that
that that's not necessarily good for your
924.4 -> body and if you're inactive if you're someone
who doesn't exercise very much i know it can be
928.72 -> tough for a lot of us and something i'm working
on but being active eating healthy not smoking
934.88 -> these all can contribute to having less chances of
having a vein occlusion whether that's in one eye
941.68 -> or both eyes and it's overall going to reduce
your chance of having a heart attack and stroke
946.4 -> and i think we can all agree those are all
important things so if you liked today's video
950.56 -> going deeper into our eye health condition go
ahead and smash that like button for me and leave
954.8 -> a comment in the section below of either your
story involving something like a vein occlusion or
960.48 -> if you have another question about an eye health
related topic or disease or treatment again drop
966 -> a question or comment in the section below because
i read those comments and i would love to get back
969.84 -> to you and possibly make a video all about that
topic otherwise if you are new here to the channel
974.56 -> make sure to hit that subscribe button down below
so you don't miss any of my future videos again
978.88 -> this is dr joseph allen here from dr eye health
keep an eye on it and we'll talk to you soon you
Source: https://www.youtube.com/watch?v=fVqER1YR-aU