Slow Vision Loss From Retinal Vein Blockage

Treatment for CRVO involves a laser procedure and anti-VEGF eye injections.

Jay Wiedmaier and his wife were newlyweds expecting their first child when they packed up their belongings and relocated from Northwest Pennsylvania to Colorado. They lived in the Centennial State for 30 years, then headed southeast and settled in Florida.

Jay on his motorcycle

Anti-VEGF eye injections every six weeks have Jay’s vision clear enough that he can safely ride his motorcycle.

“We came down to Florida six years ago to get away from the cold and snow,” says Jay, 61. “I do miss the scenery in Colorado, but the roadway system there just isn’t adequate for all the people that live there.”

Road conditions matter to Jay. After all, he’s been a professional trucker for nearly 40 years. Since earning his commercial driver’s license in 1985, he’s steered a variety of rigs – including 18-wheelers.

“These days, I drive 30-foot refrigerated trailers and deliver groceries to restaurants, bars and other places that need food,” Jay describes. “I drive five days a week, Monday through Friday. I go from Port Orange to Melbourne, Palm Bay and Cocoa Beach. I get around quite a bit.

“What I like most about my job is dealing with customers. I work with different people all the time, and I enjoy that.”

On weekends, Jay likes to take it easy. He enjoys riding his motorcycle, playing with his dogs and lounging around the house once the chores are done. In early 2021, however, Jay’s work and leisure time became threatened by problems with his vision. At risk was his commercial license, which requires the driver to undergo a medical exam every two years.

“My DOT (Department of Transportation) physical was coming up, and I was worried I wouldn’t pass the eye exam because the vision in my left eye was so blurry,” Jay recalls. “It was hard to see anything out of that eye. The blurriness really scared me.

“I visited my family doctor, and he made an appointment for me with an eye doctor. She tested the pressure in my left eye and took pictures of my eye. Then she said, Oh yeah, you’ve got something going on in there. Then she sent me to Florida Retina Institute.”

There, Jay met with William J. Dunn, MD, FACS, CHE, a board-certified, fellowship-trained retina specialist.

Dr. Dunn performed tests and discovered Jay’s left eye had developed a central retinal vein occlusion, or CRVO, a blockage in the main blood vessel that carries blood away from the retina.

Laser and Meds

“The visual acuity in his left eye was approximately 20/200, so he was almost legally blind in that eye,” Dr. Dunn reports. “His intraocular fluid pressure was normal, but the examination of his retina revealed scattered hemorrhages throughout the macula, the center part of the retina. It also showed macular edema, or swelling.”

Dr. Dunn explains that Jay possessed three of the main risk factors for CRVO: high blood pressure, diabetes and hyperlipidemia (elevated cholesterol and triglycerides). These risk factors cause the arteries in the body to become stressed, which contributes to a condition called atherosclerosis.

“With atherosclerosis, the arteries in the retina become hardened, and they press on the veins, which are soft,” the doctor explains. “Think of it this way: The arteries are like a lead pipe, and the veins are like a garden hose. When the lead pipe presses on the garden hose, the hose bends, which leads to turbulent flow through it. That produces still areas within the circulation as well as clotting, which results in occlusion of the vein.

“Individuals with CRVO lose their peripheral circulation, and that leads to the production of vascular endothelial growth factor (VEGF), which stimulates angiogenesis, the growth of new blood vessels. Unfortunately, the blood vessels that form in the retina are unstable. They hemorrhage and cause swelling, which damages the retina further.”

“I’m doing great. I passed my DOT physical with flying colors.” – Jay

For many years, the only treatment for CRVO was panretinal laser photocoagulation, which decreases the amount of VEGF produced by the compromised tissue. It also restores normal circulation by using heat from a laser to seal or destroy the abnormal blood vessels that leak into the retina.

In recent years, another treatment was developed: the intravitreal injection of medications that block VEGF. This slows the growth of abnormal blood vessels in the retina. Those medications include AVASTIN®, LUCENTIS®, EYLEA® and BEOVU®. The eye is numbed beforehand and the injections are painless.

“These medications stabilize the blood vessels, decrease leakage and slowly resolve the hemorrhaging and swelling to improve vision,” Dr. Dunn explains. “It is now standard protocol to use these medications as well as laser photocoagulation to treat CRVO.

“That is what we did in Mr. Wiedmaier’s case, and he has responded well. We see him every six weeks for an injection of EYLEA. Our goal is to keep the vision in his left eye in the 20/30 to 20/40 range, which allows him to be legal for driving and other activities.”

“It Was Amazing”

Jay is extremely pleased with the treatment, which is ongoing.

“After the second series of shots, I was right back to seeing clearly in my left eye, which was amazing,” Jay enthuses. “Now, I’m doing great. I passed my DOT physical with flying colors. And I have no trouble with my left eye as long as I keep my appointments with Dr. Dunn at Florida Retina Institute.”

Jay appreciates Dr. Dunn’s efforts to preserve his vision. He also appreciates the expertise of the retina specialist and the friendliness of his staff.

“I like Dr. Dunn. He’s a really nice guy,” Jay raves. “He’s very knowledgeable. He knows all the bits and pieces about the body and expblains them very well. He taught me what’s going on with my eyeball. He does a good job for me.

“The staff is nice as well. It’s fun to visit everybody at that practice. I highly recommend them and already have. I told a friend that I go to Florida Retina Institute, and he said, OK, that’s where I’m going.

© 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