Retinal Vein Occlusion: Risk Factors and Injection Treatments

What Is Retinal Vein Occlusion?

Retinal vein occlusion (RVO) happens when a vein in the retina gets blocked, stopping blood from flowing out. This causes fluid and blood to leak into the retina, leading to swelling and vision loss. It’s not painful, but it can hit suddenly - one moment your vision is fine, the next it’s blurry or dark in part of your eye. There are two main types: central retinal vein occlusion (CRVO), which blocks the main vein, and branch retinal vein occlusion (BRVO), which affects smaller branches. CRVO is more serious and often leads to worse vision loss. BRVO usually affects just a section of vision, like the top or bottom half of your sight.

Who’s Most at Risk?

Most people who get RVO are over 65. In fact, more than half of all cases happen in this age group. But it’s not just about getting older. The real danger comes from long-term health problems that damage blood vessels. High blood pressure is the biggest risk factor - present in up to 73% of people over 50 with CRVO. If your blood pressure isn’t controlled, your chances of RVO go up sharply.

Diabetes is another major player. About 10% of RVO patients over 50 have diabetes, and those who do tend to have worse outcomes. High cholesterol also plays a role. If your total cholesterol is above 6.5 mmol/L, your risk increases by about 35%. Glaucoma raises the risk too, especially if pressure inside the eye is high. Smoking adds to the problem - around one in three RVO patients are current or former smokers.

For younger people under 45, the causes are different. Oral birth control pills are the most common link in women. Blood disorders like polycythemia vera, leukemia, or inherited clotting conditions like factor V Leiden can also trigger RVO. These cases are rare, but they’re serious because they point to deeper health issues.

How Do Injections Help?

Injections into the eye are the main treatment for RVO - not to unblock the vein, but to treat the swelling (macular edema) that follows. The swelling is what blurs your vision. Two types of injections are used: anti-VEGF drugs and corticosteroids.

Anti-VEGF drugs - like ranibizumab (Lucentis), aflibercept (Eylea), and bevacizumab (Avastin) - block a protein called VEGF that causes leaking blood vessels. Clinical trials show these drugs can improve vision by 15 to 18 letters on an eye chart within six months. That’s the difference between barely reading a sign and reading it clearly. Aflibercept tends to work better in people with very poor starting vision, while ranibizumab and bevacizumab are effective for most.

Corticosteroid injections, like Ozurdex (dexamethasone implant), reduce inflammation and swelling too. They’re a good option if anti-VEGF drugs don’t work after several months. One study found 28% of CRVO patients gained 15 or more letters of vision after one Ozurdex implant. But there’s a catch: steroids often cause cataracts in 60-70% of patients who still have their natural lens, and can raise eye pressure, leading to glaucoma.

What’s the Treatment Routine Like?

Most doctors start with monthly anti-VEGF injections until the swelling goes down. That usually takes 3 to 6 months. Then, they switch to an as-needed schedule - you come in every few months for an OCT scan, which measures fluid in the retina. If the fluid comes back, you get another shot.

Real-world data shows patients need 8 to 12 injections in the first year. That’s a lot. Some people develop injection anxiety - the fear of the needle, the pressure, the unknown. Others struggle with cost. Bevacizumab costs about $50 per shot, while Lucentis and Eylea run $1,900-$2,000. Many clinics use bevacizumab because it’s safe and effective, even though it’s not officially approved for eye use.

There’s a new approach called treat-and-extend. You start with monthly shots, then stretch the time between them by 1-2 weeks each visit if your eye stays stable. A 2023 study showed this method gives the same results as monthly shots but cuts the number of visits by 30%.

What to Expect During the Procedure

The injection itself takes less than 10 minutes. Your eye is numbed with drops, cleaned with antiseptic, and held open with a tiny clip. The doctor uses a very fine needle to inject the medicine into the white part of your eye. You might feel pressure, but not pain. Afterward, you might see floaters or have a red spot on your eye - that’s normal. A small bleed under the surface of the eye happens in about one in four people.

Serious problems are rare. Endophthalmitis, a severe eye infection, occurs in fewer than 1 in 1,000 injections. Still, you should call your doctor right away if you have pain, worsening vision, or light sensitivity after the shot.

Long-Term Outlook and New Options

With treatment, about 30-40% of RVO patients regain vision good enough to read a newspaper (20/40 or better). Without treatment, most will lose vision permanently. That’s why sticking with the plan matters.

New treatments are coming. One is the Port Delivery System - a tiny refillable implant placed in the eye that slowly releases ranibizumab for months at a time. It’s already approved for macular degeneration and is being tested for RVO. Another is gene therapy, like RGX-314, which could let your eye make its own anti-VEGF medicine after a single injection. And there’s OPT-302, a new drug that blocks a different part of the VEGF system, being tested alongside Eylea for stubborn cases.

Doctors are moving toward personalized treatment. Your age, starting vision, other health conditions, and how your eye responds to the first few shots will determine whether you get anti-VEGF, steroids, or a mix. There’s no one-size-fits-all anymore.

What You Can Do to Lower Your Risk

Even if you’ve had RVO, you can reduce your chance of it happening again - or having it in the other eye. Control your blood pressure. Get your cholesterol checked. Manage diabetes if you have it. Quit smoking. Exercise regularly. Eat more vegetables, less processed food. See your eye doctor yearly, even if you feel fine. Early detection saves vision.

For younger people on birth control, talk to your doctor about alternatives if you have other risk factors. If you’ve had RVO under 45, ask for a blood test to check for clotting disorders. It could change your long-term care.

Living With RVO: The Real Challenges

It’s not just the shots. It’s the anxiety. The cost. The missed work. The fear that you’ll lose your independence. Many patients say the emotional toll is heavier than the physical one. Support groups help. Talking to others who’ve been through it makes a difference.

Don’t skip appointments because you’re overwhelmed. Vision can keep improving even after months of treatment. But if you stop, the swelling comes back - fast. Your doctor can help you find financial aid programs, sliding-scale clinics, or biosimilar drugs coming soon that will lower the price.

Retinal vein occlusion isn’t curable - yet. But it’s manageable. With the right treatment and support, most people keep enough vision to live independently, drive, read, and enjoy life.

Next Steps if You’re Diagnosed

First, get a full eye exam - including OCT and fluorescein angiography - to confirm the type and severity of RVO. Ask your doctor about your baseline vision and what improvement you can realistically expect. Discuss whether you’re a candidate for anti-VEGF or steroid injections. Ask about cost options and financial assistance programs.

Next, manage your overall health. See your primary care doctor to get your blood pressure, cholesterol, and blood sugar under control. If you’re under 45, ask about blood clotting tests. Quit smoking if you haven’t already.

Finally, stick with your treatment plan. Missed appointments lead to irreversible vision loss. If you’re overwhelmed, ask for help. Many clinics have patient navigators who can assist with scheduling, insurance, and emotional support. You’re not alone in this.