Branch Retinal Vein Hemorrhage

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Marty

Well-known member
Joined
Jun 10, 2001
Messages
1,597
Location
McLean, VA
About one month ago I noticed decreased vision, distortion and blind spots in my right eye. I was hoping it would be something like "floaters" or cataract but a visit to the Retina Group showed that I had a branch retinal vein occlusion. The cause of the condition is a localized thrombus in a branch retinal vein due to arteriosclerosis in an adjacent branch artery. This causes hemorrhage along the involved retinal vein. The typical patient is elderly ( which I guess I am at 77) with hypertension ( don't have it) and/or diabetes(don't have it).No treatment now but I need to see the retinologist every month for a while to make sure I don't develop glaucoma or need laser photocoagulation.
What's this got to do with warfarin? They don't seem to know. My INR is kept between 3.0 and 3.5 by weekly Coaguchek. Some retinologists advocate treatment with warfarin and others say no. I see them again on Feb 6 and let you know how its going. Some patients regain at least 20/40 vision while others go blind.
 
Sorry to hear you have this Marty. I'll be praying it doesn't get worse. Here's one excerpt about it:
From:
http://www.oralchelation.com/faq/coumadin6.htm
>>>>
A branch retinal vein occlusion is essentially a blockage of the portion of the circulation that drains the retina of blood. The arteries deliver blood to the retina. The red blood cells and plasma then course through the capillaries and eventually into the venous system, beginning with small veins and ending with larger ones, and eventually reaching the central retinal vein. With blockage of any vein, there is back-up pressure in the capillaries, which leads to hemorrhages and also to leakage of fluid and other constituents of blood. Usually, the occlusion occurs at a site where an artery and vein cross. The occlusion site determines the extent or distribution of the hemorrhage, ranging from a small vein branch to a quadrantic occlusion involving one fourth of the retina to a hemispheric (hemi-retinal) occlusion involving one half of the retina to an occlusion of the central retinal vein, which involves the entire retina (when the central vein is involved, this is called a central retinal vein occlusion which is discussed below).

Branch retinal vein occlusions are by far the most common cause of retinal vascular occlusive disease. Males and females are affected equally. Most occlusions occur after age 50, although younger patients are sometimes seen with this disorder (in this age group it is often called papillophlebitis). The highest rate of occurrence is in individuals in their 60Â?s and 70Â?s. The risk factors for this disorder are similar to those for vascular occlusive disease elsewhere in the body such as stroke and coronary artery disease. Specifically, aging, high blood pressure, diabetes, and smoking are all risk factors. Glaucoma has also been identified as a risk factor in some studies. There are less common conditions which may put a patient at risk for developing a vein occlusion including blood clotting abnormalities such as hyperhomocysteinemia, activated protein C resistance (Factor V Leiden), protein C and S deficiency, anti-phospholipid antibodies and diseases which cause sludging of the circulation or so-called hyperviscosity. Inflammatory and infectious conditions which cause vasculitis such as sarcoidosis and tuberculosis are also risk factors for vein occlusion.
>>>>

Did they check your homocysteine level? Here's an article that says high levels of homocysteine may play a role in BRVO

From:
http://www.lef.org/magazine/mag2001/june2001_report_homocysteine.html
>>>>>
Eye problems

Just as blood vessels leading to and from the heart and brain can be adverstely affected by homocysteine, so can other blood vessels in the body. Central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and nonarteritic anterior ischemic optic neuropathy (NAION) are three eye conditions associated with elevated homocysteine. All are serious conditions that can lead to vision loss. Ischemic CRVO, which usually occurs in one eye only, leads to all sorts of complications including neovascular glaucoma and macular degeneration. There is no good treatment, and in fact, some researchers believe that treatment will make the condition worse.

In a new study from the University of Michigan, the average homocysteine level was 11.58 micromoles per liter for people with CRVO versus 9.49 for people without. Elevated homocysteine was present in half of all eyes with severe loss of vision caused by CRVO. Because these eye conditions are frequently associated with diabetes, hypertension, cardiovascular and other systemic diseases, a complete physical is highly recommended for anyone diagnosed with any of these eye problems.
....
What you can do

There are three principle vitamins involved in the conversion of homocysteine: folate, vitamins B6 and B12. Vitamin B2 (riboflavin) is required for the B6 pathway of homocysteine reduction.

Folate adequately lowers homocysteine in some people. Published studies show that folate supplements (0.5-5 mg/day) reduce homocysteine anywhere from 12% to 30%. In a recent study on cervical dysplasia, women were given 10 mg of folic acid a day, whether they were deficient or not. Homocysteine was significantly reduced at eight weeks, with a continuing trend downwards at six months.

Folate is one answer to homocysteine, but itâ??s not the only answer. Other vitamins help too. Vitamin B12 must be available for folate to work, and vitamin B6 must be present for homocysteine to be converted to cysteine and other beneficial sulfur-type molecules.

Another pathway for the detoxification of homocysteine utilizes betaine (TMG) and requires no vitamin cofactors. Betaine can be taken in conjunction with folate if folate doesnâ??t reduce homocysteine to a satisfactory level. (Relying on betaine alone, however, is not advisable since folate has numerous important functions in addition to reducing homocysteine.
....

Age is another factor that elevates homocysteine. Unfortunately, age-related hyperhomocysteinemia hasnâ??t been adequately investigated. However, the data on the dangers of homocysteine is already so compelling that researchers are now urging doctors to do routine testing.

Note: For additional information on what can be done to lower homocysteine levels when folic acid supplements fail, refer to the March 1999 issue of Life Extension (â??A Lethal Misconceptionâ?�) or refer to the Internet magazine archives section at www.lef.org.

References
....
Pianka P, et al. 2000. Hyperhomocystinemia in patients with nonarteritic anterior ischemic optic neuropathy, central retinal artery occlusion, and central retinal vein occlusion. Ophthalmology 107:1588-92.

Vine AK. 2000. Hyperhomocysteinemia: a risk factor for central retinal vein occlusion. Am J Ophthalmol 129:640-4.
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Marty-

I am so sorry to hear of this problem. I am sure you have to best docs working on it and you will be my thoughts and prayers that it will give you minimal problems and will resolve eventually.

God Bless.
 
Thank you

Thank you

Thanks Jim, You found some info that I hadn't come across in my search. I found the homocysteine particularly interesting and may try a folate supplement. Thanks, Nancy. You know, gettin' old is not for sissies.
 
Joe says that too Marty. Just keep chugging along, keep the devil at bay.

Remember what I always say, don't panic, most things never reach the worst case scenario. Most things resolve or get help that will halt the course of things. And---go sooner rather than later. Keep your docs "on their toes", keep 'em sharp. :p
 
Marty, I'm hoping for the best possible outcome for you.

You are an inspiration for all of us on VR.com
and I just want to say Thank You for your contributions.

'AL Capshaw'
 
One site seems to imply that a retina vein occulsion is not due to metal heart valves but that a retina artery occulsion may be -
From:
http://www.wa-eyemd.org/W_vascular_eye_diseases.htm
>>>>>
More commonly , retinal arterial occlusive disease is associated with ' hardening of the arteries ' ( atherosclerosis ) or valvular heart disease or prosthetic heart valves . Blood clots can form on diseased arterial walls or diseased heart valves , and small pieces of clot can break off and float in the bloodstream , until they become lodged in retinal arteries .
>>>>>
 
Hmm, interesting

Hmm, interesting

Jim, Its a possibility. These mechanical valves are associated with thrombi and emboli even in the well anticoagulated and this would clog an artery. However the retinologists say the vein occlusion and hemorrhage gives a characteristic picture easy to dx.I also had one of the fluoroscein angiograms that confirmed the clinical diagnosis. Its a vein occlusion caused by an arteriosclerotic crossing artery resulting in hemorrhage. Now I've got to wait and see if the retina can recover from this insult. If not my visual problems are permanent.
 
Hi Marty,

So sorry to hear it. Hope you regain your full visual field.

Just brings to mind all of the visual disturbances some of us experience. I have them constantly. Migraines. Last week or so dizzy spells not related to my heart or meds they tell me.

If I would like and event montior....they will set me up.My vitals are all normal. Check them frequently at home too. So after some thought........ made an appointment for an eye exam next week. My entire family wears glasses....why would I be any different.

My "dizzy spells, visual effects (which do include floaters) may be nothing more than an optical issue. It goes in spurts. Has also been suggested to be hormonal. I try to blame everything on the valve. Have to stop doing that;) It's done me a great service the last five years and I am happy to be around.

Please keep us posted. I will post my findings after my eye exam next week. Maybe this OD has an idea why valve patients experience visual disturbances in the first place!
 
Marty-

Several years ago I experienced a "curtain" effect in one of my eyes, and it scared me half to death. I did go to a retina specialist. I don't recall whether he gave me the medical term for what it was, but he said that as the eye ages, the retinal area gets drier and that is was some blood leakage in that area. It lasted for, maybe a month or more, and slowly returned to normal, as the blood resorbed. It was a very uncomfortable feeling to have only half vision in one eye, and I found it disconcerting. Fortunately, nothing like ever happened since, "knock wood".

Probably not the same thing at all, but I wanted to share it with you.
 
Gina and Nancy

Gina and Nancy

Gina, I don't think you have retina problems. To reassure youself ask your eye doctor for a referral. Nancy you had some type of retinal bleed , separation, etc. that healed itself. Alice has something called cellophane retinopathy that is associated with floaters. Her vision is still good. Our Retina Group is something.
15 doctors, huge waiting room with every seat filled. I didn't realize what a big problem retinas were. I'm sure I will learn more as I have to see my guy every month for a while. I'll give you progress reports.
 
Sorry about the bad news, Marty.

I've been doing a lot of thinking about folic acid. It may offer the biggest bang for the buck in mediciane.

It prevents neural tube defects such as spina bifida in unborn children.

It can prevent heart attacks and now we read that it can prevent clots in the retina.

It is extremely cheap. You can buy hundreds of them for a few dollars at the grocery store.

It is almost non-toxic. If you overdose, all you do is produce folate-rich urine.

I think it comes as close to being the ideal drug as anything on the market.
 
Folic

Folic

Al, I agree. Alice will pick up a bottle at RiteAid today and I'll start taking it with my daily Coumadin 3mgm. No problem of interaction is there?
 
Marty-

Joe has to take 1 mg. (prescription strength) folic acid each day for his anemia, along with iron (Feosol) 2 X day and Procrit injections 3 X week.
 
Look into the new drug Aranesp. It is like Procrit but many people only need a shot every 2 weeks.
 
2nd visit

2nd visit

I saw the retinologist today. He said my bleed hadn't gotten any worse. It may take months to resolve a little. In 3 to 6 months they might consider laser photocoagulation but the bleed is too fresh now. I asked about Coumadin. The short answer is -it doesn't hurt and doesn't help the eye. Apparently there have been many studies . I said my internist suggested keeping INR near 2.5 rather than 3.5. He said OK but it doesn't make any difference in the eye. Folic acid? No evidence that it helps.
 
Hi Marty!

Was just thinking about you. Happy to hear your bleed is stable.

Finally had my eyes checked out today. Everything was fine.
May require some reading glasses in a few years. But nothing major. He ran me through the gamete. They had a camera that actually takes a photo of the inner eye. Mine looked so good compared to those hanging on the wall. What heart disease, diabetes, etc can do to your eyes. He checked for clots, hemorrhage, scaring. None of the above. So I have never had an eye bleed, etc. He said it looked remarkable for someone that's been on Coumadin.

Back to square one. May be hormonal they say. Neuro exam was fine too.

Please keep us posted. Take care.
 
Gina wrote:

"He said it looked remarkable for someone that's been on Coumadin. "

That sounds ominous...

SO, what can we (Coumadin patients) expect to happen to our eyes over 10 or 20 years?

'AL Capshaw'
 
Gina's eyes, Al don't worry

Gina's eyes, Al don't worry

Gina, You have great eyes inside and out. keep it that way. Al, don't worry about the Coumadin. The retinologist told me Coumadin doesn't cause the hemorrhage or prevent thrombi in retinal veins.The cause is usually arteriosclerosis where the artery crosses a vein, hypertension, and/or diabetes. Don't get any of those and your eyes will do well. I don't have hypertension or diabetes but heck at ,77 I think I'm entitled to a little arteriosclerosis.Gina's eye man probably sees a lot of old people on Coumadin for afib, DVT, etc. He will see a lot of bad eyes but its not due to the Coumadin.
 
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