Eye Injections Manage Retinal Vein Occlusion

Anti-VEGF medications halt vision loss and reduce other complications.

Russ Williams played football and baseball while attending the University of Dayton in Ohio. Upon graduation in 1981, he acknowledged what most college athletes do — that he would never play either sport professionally. So, he went into broadcasting, which he studied as an undergrad. His career spanned nearly four decades.

Russ’ vision, with glasses, is now 20/20 in both eyes, which he considers a “blessing.”

“I was primarily an outside sales associate in radio and cable TV advertising. However, I did just about everything for the stations except climb the towers,” shares Russ, 66. “I performed a lot of promotional and sales duties, but I also recorded voiceovers and commercials. I broadcasted sports and special events as well.”

For the most part, Russ worked for stations in small and medium markets, beginning in Dayton. Eventually, he relocated to Florida and worked for radio stations and cable companies in various small markets.

“A cable company I worked for in Central Florida was instrumental in getting Daytona Beach hooked up with MTV’s spring break promotion in 1986,” Russ reveals. “I was very involved with that. I provided a lot of the legwork and background work. It was a trailblazing event to link a local cable company and an international cable network on the road.”

After Russ retired, he took on a new role at home: full-time caregiver. He helped his wife manage multiple hospital and specialists visits and deal with fluctuating symptoms until her death from metastatic breast cancer in February 2020. Being a caregiver heightened Russ’ awareness of his own health.

“About six years ago, I noticed a problem with the eyesight in my left eye,” he remembers. “My vision was blurry. I had a difficult time seeing. I didn’t have any trouble driving and I didn’t have any accidents or anything, but it was a challenge to clearly see what was going on in front of me. There was no pain, but when I read, my eyes got extremely tired, and my left eye got a little red and irritated.

“I thought perhaps my vision was being impaired by a stye growing on the outside of my eye. I visited a specialist to have it looked at, but it turned out the growth had nothing to do with my vision difficulties. The specialist determined that something more serious was going on and directed me to Florida Retina Institute.”

At Florida Retina Institute, Russ met with Jaya B. Kumar, MD, FASRS, a board-certified, fellowship-trained retina specialist.

“Mr. Williams initially came to us in 2016,” Dr. Kumar recalls. “He suffered a sudden, painless loss of vision in his left eye. His vision was blurry and distorted. After an exam and testing, we discovered he had a retinal vein occlusion.

Inflammation Cascade

A retinal vein occlusion is a blockage in the small veins that carry blood away from the retina, the light-sensitive layer of nerve tissue lining the back of the eye. Retinal vein occlusion is a common cause of vision loss.

“Think of it like someone stepping on a firehose and causing a backup of blood and fluid in the vein,” Dr. Kumar describes. “There are several complications when this backup occurs. For one, blood is not able to drain out of the eye. As a result, the blood vessels begin to leak, causing swelling of the tissues around the vein.

“Cholesterol deposits and blood leak from the vessels, which damage the retinal tissues. In addition, the eye releases vascular endothelial growth factor, or VEGF. This triggers a cascade of inflammation that causes swelling in the eye, bleeding and the creation of scar tissue.”

VEGF also signals the formation of abnormal blood vessels, which can leak and cause swelling and vision loss. The main treatment for retinal vein occlusion is the injection into the eye of anti-VEGF medication to halt the progress of these vessels.

“When I put on my glasses I can see like I used to when I was half my age.” – Russ

An occlusion often occurs when the vein is “pinched off” due to the pressure of the retinal artery on top of it or when a blood clot interrupts blood flow. Certain factors increase a person’s risk for developing the condition.

“The main risk factor for retinal vein occlusion is high blood pressure,” Dr. Kumar warns. “Other risk factors include having diabetes, glaucoma, and certain types of cancer or vascular conditions that increase the likelihood of developing a blood clot. Retinal vein occlusion is more common in people over 50.”

To diagnose an occlusion, retina specialists begin with a dilated eye exam, which provides a clear view of the retina. It can reveal abnormal blood vessels as well as bleeding and swelling in the retina and macula, the center portion of the retina. This bleeding and swelling cause blurry vision.

“We may also use certain tests to assist in making the diagnosis,” Dr. Kumar observes. “One is optical coherence tomography, or OCT, which in an imaging exam that details the layers of the retina.

“Sometimes, we perform a fluorescein angiogram. During this test, we inject a plant-based dye called fluorescein into a blood vessel in the arm. We then take pictures of the blood vessels in the back of the eye as the dye passes through them. Certain patterns on the images suggest a diagnosis of retinal vein occlusion.”

“A Definite Blessing”

There is no cure for retinal vein occlusion, but it can generally be managed successfully with ongoing treatment, Dr. Kumar assures.

One of the FDA-approved anti-VEGF medications used for treating retinal vein occlusion is bevacizumab, trade name AVASTIN®. Others are ranibizumab, brand name LUCENTIS®, and aflibercept (EYLEA®).

“In 2018, I switched Mr. Williams’ anti-VEGF medication from AVASTIN to EYLEA, which is a little stronger and can last a little longer than AVASTIN,” the doctor reports. “Today, we are treating him with EYLEA injections every three months. And he is doing well. His vision is excellent.”

Russ elaborates.

“My condition has gotten remarkably better,” he enthuses. “Before the injections, my eyesight, even with glasses, wasn’t anywhere near what it is now. My vision right now is great. With my bifocal prescription, I’ve got 20/20 vision in both eyes. I consider that a definite blessing. When I put on my glasses I can see like I used to when I was half my age.”

Not only is Russ amazed by his outcome, he’s also impressed by the retina specialist that helped him achieve it.

“Dr. Kumar is an incredible doctor,” Russ raves. “She’s very knowledgeable and up to date with all the treatments. And she has a very good doctor-patient philosophy. Having a good relationship with your doctor is critical when you’re dealing with your eyesight. I have that with Dr. Kumar.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. mkb
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    • Florida Retina Institute

      Founded by James A. Staman, MD in 1979, Florida Retina Institute has 19 locations throughout Central Florida, North Florida, and Southeast Georgia. They have proudly delivered Excellence in Vitreo-Retinal Diseases and Surgery for 40 years. T... Read More

    • Jaya B. Kumar, MD, FASRS

      Jaya B. Kumar, MD, FASRS, is certified by the American Board of Ophthalmology and is a fellow of the American Society of Retina Specialists. She earned a Bachelor of Science degree with honors and a Doctor of Medicine degree at Saint Louis U... Read More