Traffic Jam In The Eyes

Hypertension is a main risk factor for retinal vein occlusion.

Cheryl Bell and her husband have owned a successful lawn care business for 16 years. Cheryl is no silent partner. She mows and blows clippings off sidewalks and driveways once her husband finishes the weed-cutting and edging. 

Anti-VEGF injections have decreased the swelling in Cheryl’s right eye.

Anti-VEGF injections have decreased the swelling in Cheryl’s right eye.

She also has three children to raise and sells real estate. Her interest in real estate has deep roots.

“Years ago, my husband had a real estate license and I had a mortgage broker’s license,” recounts Cheryl, 53. “We bought and sold properties and sometimes rented them out. We wanted to establish an inheritance for when our girls reached the point that they wanted to have a home.

“My husband and I are interested in finding properties, doing some rehab and flipping them. We’ve done that with a couple of properties already. Right now, though, the market is ridiculous, so we’re waiting to see what happens with that.”

The real estate market isn’t the only thing that had Cheryl on hold this year. In February, she visited her ophthalmologist to update her contact lens prescription and learned she had suffered a stroke.

“My blood pressure was 200 over 119 so they sent me to the emergency room,” Cheryl remembers. “I didn’t have any symptoms; I didn’t feel bad. I knew my blood pressure was up but had no idea it was that high. 

“I take natural medicine because I don’t like taking pharmaceuticals, but apparently the natural stuff wasn’t enough to keep my blood pressure down. The staff in the ER told me I was the sickest person in the hospital at the time, even with the COVID-19 patients.”

Once Cheryl recovered and her blood pressure stabilized, she returned to her ophthalmologist for her new lens prescription. During the examination, her eye doctor noticed fluid building up in her right retina, the light-sensitive nerve tissue that makes up the back wall of the eye. The doctor referred Cheryl to Florida Retina Institute, where she met with Ruwan A. Silva, MD, MPhil, a fellowship-trained retina specialist.

“Cheryl initially came to us on August 5, and she was experiencing some blurry vision in her right eye,” Dr. Silva reports. “When we examined her eye, we saw that the macula, the very back portion of the retina that’s responsible for detailed vision, was swollen.

“We performed additional tests and discovered that one of the blood vessels in the back of her eye was blocked, a condition called retinal vein occlusion. When this occurs, the backup of fluid causes swelling, which leads to blurry vision.” 

Four-Way Intersection  

There are several risk factors associated with retinal vein occlusion, including getting older and having diabetes, Dr. Silva notes. But the most significant and most common is a history of hypertension, or high blood pressure.

“With high blood pressure, the arteries and veins undergo changes that can cause a blockage in the blood vessels, especially in the eyes,” Dr. Silva observes. “The eye’s arteries and veins cross over each other, and these intersections become problematic in patients who have hypertension.

“It’s like a traffic jam in the eyes. Normally, there’s a four-way intersection where one of the roads is an artery and the other is a vein. When a person has high blood pressure, these intersections get very congested due to changes to the arteries, which ultimately cause a blockage in the veins.”

There are two main treatments for retinal vein occlusion. 

The first involves injections of anti-vascular endothelial growth factor (anti-VEGF) medication into the eyes to help ease swelling. There are three FDA-approved anti-VEGF medications used by the specialists at Florida Retina Institute: bevacizumab (brand name AVASTIN®), ranibizumab (LUCENTIS®) and aflibercept (EYLEA®).

“These medications stabilize the changes to the blood vessels and prevent more fluid from leaking into the back of the eye,” Dr. Silva describes. “This gives the patient’s body an opportunity to resorb the fluid that has already accumulated.”

The second treatment is a laser procedure applied to damaged areas of the retina to prevent bleeding.

“When there’s a blockage in the blood vessels, certain areas of the retina are damaged,” Dr. Silva discloses. “The body responds by growing new blood vessels in the back of the eye. But these blood vessels are problematic. They leak and cause even more damage. 

“By applying a laser to the damaged areas of the retina, this process can be ameliorated. Stopping this process decreases the chances that the patient will develop complications such as active bleeding or glaucoma.”

Like many retinal diseases, there’s typically no pain or eye irritation associated with retinal vein occlusion, Dr. Silva points out. When it first occurs, patients often experience mild changes to their central or peripheral vision.

“Patients often ignore these vision changes,” Dr. Silva states. “But any changes to vision, whether accompanied by discomfort or irritation or not, should be evaluated. Even minor changes can represent serious disease. But if caught early, retinal vein occlusion can be treated effectively, and patients can achieve great outcomes.”

Excellent Progress

Dr. Silva is treating Cheryl’s retinal vein occlusion with anti-VEGF injections into her right eye. Cheryl was at first quite terrified of the injections and still gets nervous about them, but Dr. Silva and the staff at Florida Retina Institute help put her at ease.

“First, they place a solution in my eye that numbs the outside of the eye,” Cheryl describes. “Then they give me a numbing shot. The first one I got hurt, but the actual shot with the medicine didn’t hurt at all. The second time I went they put in more numbing drops and nothing hurt.

“I always get afraid before an injection, but Dr. Silva and his staff make me feel better. They tell me to breathe and say, Everything will be OK.” 

Cheryl reports that she’s made excellent progress with her retinal vein occlusion treatment.

“My eye is getting better,” she enthuses. “Dr. Silva said the fluid is going down and my retina looks really good. Dr. Silva said my vision probably won’t improve, but I don’t have the fluid and they were worried about the swelling behind my eye causing damage.

“I’m happy with my treatment and with everybody at Florida Retina Institute. Dr. Silva is amazing. He’s so nice. He talks to me and makes me comfortable. He’s knowledgeable and easy to talk to. And the staff has really nice people. I recommend them.” 

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. Graphic courtesy of Health Jade.mkb
Print This Article
    • 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

    • Ruwan A. Silva, MD, MPhil

      Ruwan A. Silva, MD, MPhil, completed his undergraduate education with highest honors at Harvard University in Cambridge, MA, majoring in neurobiology. He earned a Master of Philosophy degree in neurobiology from Cambridge University in En... Read More