Comments on: Valentines Day has left me partially blind

Question: Valentines Day has left me partially blind

msali — Thu, 14 Feb 2008 12:31:53 -0800

Is there an ophthalmologist in the house? School me on central retinal vein occlusion.

I woke up this morning and couldn't quite wipe the fuzzies out of my left eye. Before too long, I realized that those fuzzies were in my eye, not on it. Concerned, I scheduled an exam with my local optometrist who tentatively diagnosed me with central retinal vein occlusion.
Pretty common eye disorder, so it seems, if you are over the age of fifty. Being a 35 year old woman of sound mind (hah!) and body, I guess it is fairly uncommon. This optometrist referred me to a retinal specialist, and cautioned me to take an aspirin and not do much until my appointment tomorrow morning. My understanding is that there is no treatment for "CRVO", rather it is more important to determine the cause. My own research is freaking me out, so I thought I would pose it to my internet friends. What know ye of this illness in the young?

By: mightshould

mightshould — Thu, 14 Feb 2008 13:02:53 -0800

Don't know about the condition in the young, but my Mom has been through this, and we went with her to the doctor's to ask questions.

From your research, you know the basics - it's a problem in the vein serving part of the retina. My Mom's happened when she was on vacation. When back in the country, she went to the local eye specialist, who didn't offer many options. (small town) She then went to the Wilmer Eye Institute and was seen by Dr. Finklestein who is a specialist. By the time they saw her, there wasn't much they could say. Some docs suggest laser surgery, while others say it's a waste of time. (this may depend on the exact problem or location.) I don't know the most current research since her problem was about 8 years ago.

The specialist may determine something else is the problem. When you are at their office tomorrow, the retina specialist will put a dye in the eye and take pics to see the vessels. That's the key it seemed to me. The concern is that if there's a problem with the blood flow it can cause damage to the nerve, which is what happened to her. They thought part of her problem was a spike in blood pressure since she was in China, eating the local food which contained more sodium (but that is speculative guessing at this point.)

Presently, she can still see out of that eye - but there are black spots where the damage was permanent. Hopefully a more knowledgeable person will respond. But, be assured that this is not an end-all thing. Mom still does anything she wants to do.

By: sulaine

sulaine — Thu, 14 Feb 2008 13:23:53 -0800

If you are interested in getting into a study, there is a clincial trial looking at the standard treatment (laser) vs. steriod injections for vein occlusions. Enrollment ends at the end of February. Here are the clinic sites.

By: Stewriffic

Stewriffic — Thu, 14 Feb 2008 13:58:11 -0800

Also, consider seeing an ophthalmologist (MD) rather than an optometrist, if you can. Optometrists are kind of parallel to a primary care physician and specialize more often in glasses/contacts, etc. They're both good, but I'm guessing you'll probably be referred out to an ophthalmologist anyway...

By: Stewriffic

Stewriffic — Thu, 14 Feb 2008 14:21:31 -0800

Oops. Misread. Sorry 'bout that.

By: mothershock

mothershock — Thu, 14 Feb 2008 17:33:00 -0800

My husband is an ophthalmologist (though of course not YOUR ophthalmologist) and he says:

"CRVO occurs as a spectrum of disease that is broadly categorized into ischemic and non-ischemic CRVO, the determination of which is based upon your visual acuity and evidence of retinal ischemia as seen on fluoroscein angiography at the retina specialist's office. (Ischemic means, basically, lack of blood flow and oxygen.) It's very important to do a few things -- first of all, to see the retinal specialist, who will not only be able to characterize whether it's ischemic and non-ischemic (or somewhere in the middle), but will also follow you to see if it evolves.

In ischemic CRVO, it is extremely important to follow up regularly to identify the development of neovascular glaucoma, which can be treated before it becomes a huge problem. Generally, if you had ischemic CRVO, your vision would be very poor (more than just a bit of blurriness). Also, I'm not sure what the optometrist saw, but an optometrist is not a medical doctor, and you may not have a CRVO.

If you really do have a CRVO, the most important thing is to do a hypercoaguable workup, which means looking to see if there's any reason that you have a propensity to clot. This could be very important to identify, and I would typically involve a hematologist. (The retinal specialist should initiate the workup/referral.) There are lots of potential causes of hypercoaguability, but a common culprit is oral contraceptives / hormone supplements -- consult with your doctor, but stopping oral contraceptives would be a good idea for the time being."

If you have other questions, feel free to MeMail -- but hopefully the retinal specialist and your primary care physician can help with some answers.