Retinal Vein Occlusion Monitoring: Tests and Follow-Up Schedule

Retinal vein occlusion (RVO—branch or central) requires structured monitoring to detect complications (macular edema, neovascularization) and guide treatment.

Monitoring Modalities

1. Visual acuity (VA): ETDRS or Snellen at each visit; tracks functional impact.
2. Dilated fundus exam: Assesses hemorrhages, cotton-wool spots, disc edema, neovascularization of disc/retina/iris (NVD/NVI).
3. Fundus photography: Documents baseline and changes; widefield useful for peripheral non-perfusion.
4. Optical Coherence Tomography (OCT): Quantifies macular thickness, detects subretinal/intraretinal fluid, monitors edema response to anti-VEGF/steroids.
5. Fluorescein Angiography (FA): Gold standard for capillary non-perfusion, leakage, neovascularization. Guides laser/anti-VEGF decisions.
6. Indocyanine Green Angiography (ICGA): Choroidal circulation; adjunct in central RVO (CRVO).
7. Amsler grid: Patient self-monitoring for metamorphopsia/scotoma (macular involvement).
8. Intraocular pressure (IOP): Monitor for neovascular glaucoma (NVI → angle closure).
9. Blood pressure: Systemic hypertension is major risk factor; control improves prognosis.

Typical Follow-Up Schedule

• Acute phase (0–3 months): Every 4–6 weeks (more frequent if treated with anti-VEGF).
• Stable/quiescent: Every 3–6 months for 2+ years (late neovascularization can occur).
• Fellow eye: Assess risk factors; 10–15% develop RVO in fellow eye at 5 years.

Treatment Triggers

• Macular edema affecting vision → anti-VEGF (aflibercept, ranibizumab, bevacizumab) or dexamethasone implant.
• Neovascularization (NVD/NVE) → panretinal photocoagulation (PRP) ± anti-VEGF.
• Neovascular glaucoma → urgent IOP control + PRP + anti-VEGF.

Adherence to monitoring preserves vision.