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66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. He has seen you a few times for this and now has come down to Florida for the winter. He notices the right eye does not see as good as the left eye. VISUAL ACUITY: Vision OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. SLIT LAMP EXAM: There are unusual looking corneal specks in the superficial stroma, which are evenly distributed throughout the central cornea and not affecting the view of the posterior pole. There is 2+ nuclear sclerosis. The left eye also shows superficial unusual round, small stromal specks and 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate. OS: Vertical C/D ratio is 0.2. There are 2+ arteriovenous crossing changes. OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns, not unlike the scan you described the letter. The left eye has slight parafoveal thickening. The foveal center though is normal. FLUORESCEIN ANGIOGRAPHY: FA is obtained and shows modeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea. IMPRESSION: 1. SUPEROTEMPORAL MACULAR BRANCH RETINAL VEIN OCCLUSION – RIGHT EYE 2. MACULAR EDEMA – RIGHT EYE 3. HYPERTENSIVE RETINOPATHY – BOTH EYES 4. UNUSUAL CORNEAL STROMAL OPACITIES, PROBABLY DYSTROPHIC – BOTH EYES 5. CATARACTS DISCUSSION: I explained to the patient that with swelling of the retina, the decreased vision, and the persistence of the macular edema, at this point he is an excellent candidate for laser treatment which has about a 50-75% chance of drying up the macula and improving his vision. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I treated him today without any difficulty, and I warned him that sometimes re-treatments are necessary and that the vision generally improves slowly

bvooldcollaterals.jpg
BRVO with collaterals and cystoid macular edema360 views66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate.
OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns FA: shows remodeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea.
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BRVO with collaterals and cystoid macular edema205 views66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate.
OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns FA: shows remodeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea.
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bvooldcollaterals_28129.jpg
BRVO with collaterals and cystoid macular edema167 views66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate.
OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns FA: shows remodeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea.
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bvooldcollaterals_28229.jpg
BRVO with collaterals and cystoid macular edema178 views66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate.
OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns FA: shows remodeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea.
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BRVO with collaterals and cystoid macular edema102 views66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate.
OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns FA: shows remodeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea.
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bvooldcollaterals_28329.jpg
BRVO with collaterals and cystoid macular edema213 views66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate.
OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns FA: shows remodeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea.
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BRVO with collaterals and cystoid macular edema108 views66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate.
OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns FA: shows remodeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea.
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bvooldcollaterals_28429.jpg
BRVO with collaterals and cystoid macular edema157 views66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate.
OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns FA: shows remodeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea.
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66 Year Old Man with has had a branch retinal vein occlusion in the right eye with vision loss for the last few months. He has seen you a few times for this and now has come down to Florida for the winter. He notices the right eye does not see as good as the left eye. VISUAL ACUITY: Vision OD is 20/40, OS is 20/20. IOP: OD 18, OS 19. SLIT LAMP EXAM: There are unusual looking corneal specks in the superficial stroma, which are evenly distributed throughout the central cornea and not affecting the view of the posterior pole. There is 2+ nuclear sclerosis. The left eye also shows superficial unusual round, small stromal specks and 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a superotemporal macular branch retinal vein occlusion with edema, hemorrhage, and exudate. OS: Vertical C/D ratio is 0.2. There are 2+ arteriovenous crossing changes. OCT SCAN: The right eye shows edema with a central foveal thickness of 354 microns, not unlike the scan you described the letter. The left eye has slight parafoveal thickening. The foveal center though is normal. FLUORESCEIN ANGIOGRAPHY: FA is obtained and shows modeling of the superotemporal vasculature. There are already venous-venous collaterals, suggesting the vein occlusion may be a little more than a few months old. There are multiple microaneurysms superotemporal to the fovea, and there is leakage in the late frames involving the fovea. IMPRESSION: 1. SUPEROTEMPORAL MACULAR BRANCH RETINAL VEIN OCCLUSION – RIGHT EYE 2. MACULAR EDEMA – RIGHT EYE 3. HYPERTENSIVE RETINOPATHY – BOTH EYES 4. UNUSUAL CORNEAL STROMAL OPACITIES, PROBABLY DYSTROPHIC – BOTH EYES 5. CATARACTS DISCUSSION: I explained to the patient that with swelling of the retina, the decreased vision, and the persistence of the macular edema, at this point he is an excellent candidate for laser treatment which has about a 50-75% chance of drying up the macula and improving his vision. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I treated him today without any difficulty, and I warned him that sometimes re-treatments are necessary and that the vision generally improves slowly