Branch Retinal Artery Occulsion

About Branch Retinal Artery Occlusion

A branch retinal artery occlusion (BRAO) is usually marked by a painless and abrupt onset of peripheral vision loss and, in some cases, central vision loss. The cause of the condition is usually related to an embolus (clot or plaque) from a carotid artery (in the neck) or the heart. While no ocular therapy has been proven valuable, some ophthalmologists may attempt to dislodge the embolus if the condition has been present for less than 24 hours. Methods include ocular massage, anterior chamber paracentesis (tapping fluid from the eye), or administration of glaucoma agents.

Treatment

Loss of visual acuity with a BRAO will mostly depend on whether there is disruption of arterial blood flow to the macula or the presence of significant macular edema (swelling). Patients will be evaluated for cardiovascular risk factors and treated accordingly, often with a family or internal medicine physician involved. The majority of patients are found to have carotid artery disease (narrowing), high blood pressure, cardiac disease, or combinations of these disorders. Less commonly, infectious, inflammatory or hereditary conditions can be the cause.

Most patients will be evaluated from an ophthalmic standpoint every 3 to 6 months until stable. The prognosis for vision depends on whether or not the central macula was initially affected. In general, poor vision upon presentation is indicative of a poor visual outcome. Approximately 90% of patients will recover visual acuity of 20/40 or better, though most patients will have noticeable permanent visual deficits.

In rare cases patients may develop other complications as a result of BRAO, such as neovascularization of the retina and iris and neovascular glaucoma. Now, new treatments are available which can preserve and even restore vision in some patients. We specialize in these therapies here at the Retina Macula Institute.