CRVO Update

Like I posted before, I got CRVO (Central Retinal Vein Occlusion), or Papillophlebitis as it is sometimes known, in my right eye. I had a followup visit with my retina specialist this week.

I had already noticed that the dark cotton wool spots I was seeing earlier were almost gone. The doctor confirmed that quite a lot of the retinal hemorrhage is gone now. In fact, he was surprised at the speed of recovery and that my central vision was never affected.

Even though my bloodwork was normal, he advised me to see a specialist, a hematologist I hear they are called, to do more tests than the dozen blood tests he has already done. There goes a liter of my blood.

I also have the impression that my doctor has not had much experience retinal vein occlusions in healthy young adults. I think it is fairly rare in that case.

CRVO

If you were wondering why I ranted about God or why my family is pressuring me to not spend so much time on the computer, you should really get a life. grin. I guess I am going to tell you in any case.

WARNING: Reading medical info can be bad for a layperson. Read at own risk.

The reason is CRVO in my right eye. That is central retinal vein occlusion. Here is a basic description:

The retina of the eye is the sensory organ for vision. If the eye is compared to a camera, the retina would be the film where the “picture” is formed. Proper blood circulation is needed for the retina to function. Normally, blood flows into the retina through the Central Retinal Artery and leaves the eye through the Central Retinal Vein. Both of these blood vessels enter the eye through the optic nerve.

CRVO is caused by a blood clot in the vein that drains the blood from the retina of the eye. The arterial blood enters the retina but cannot leave it due to a blockage in the vein.

As a result, blood and fluid are backed up into the retina, which causes a loss in vision. Over time, the blood vessels in the retina may close leading to further loss of vision with the possible development of new abnormal blood vessels. These new vessels may cause a very painful type of glaucoma and lead to total blindness. Traditionally, there has been no reliably effective treatment to prevent the loss of vision or to improve vision once it has been lost.

Patients with high blood pressure, diabetes, or glaucoma are at an increased risk for developing CRVO. One researcher estimates that approximately 60,000 people develop a CRVO each year in the United States.

The risk factors for CRVO are old age, diabetes, high blood pressure, etc. However, some young healthy adults, like me, also get this disease due to unknown reasons. In that case, it is sometimes known as Papillophlebitis.

I noticed it more than 3 weeks ago in the form of a couple of floaters (i.e., small dark spots in my right eye) and it was diagnosed a day before I wrote that rant. The floaters changed to a dark web in the upper visual field in my right eye. It was very annoying at first, but I got used to it or it got better and I don’t even notice it most of the time now.

Today, I had an appointment with a retina specialist who dilated my pupils and shone lots of light into my eyes. He also did Fluorescein Angiography. The results are hopeful, though I have to see him every month.

There are two kinds of CRVO: ischemic and non-ischemic.

Nonischemic CRVO is the milder form of the disease. It may present with good vision, few retinal hemorrhages and cotton-wool spots, no relative afferent pupillary defect, and good perfusion to the retina. Nonischemic CRVO may resolve fully with good visual outcome or may progress to the ischemic type.

Ischemic CRVO is the severe form of the disease. CRVO may present initially as the ischemic type, or it may progress from nonischemic. Usually, ischemic CRVO presents with severe visual loss, extensive retinal hemorrhages and cotton-wool spots, presence of relative afferent pupillary defect, poor perfusion to retina, and presence of severe electroretinographic changes. In addition, patients may end up with neovascular glaucoma and a painful blind eye.

Ischemic is a dangerous and more severe form which often leads to complications and very poor vision. Non-ischemic CRVO is a mild or benign disease. However, it might progress to ischemic CRVO over time. The risk of that happening is about 12% within 18 months of the onset of CRVO. That is why it is important to regularly monitor my non-ischemic case.

There are some experimental treatments but no real treatment. In the ischemic case, doctors usually treat complications while for the non-ischemic, they just monitor the patient. In quite a few non-ischemic cases, the blocking of the vein clears itself and there is no major loss of vision.

To make things more interesting, I have minimal vision in my left eye.

NEXT: Update here.