Branch Retinal Artery Occlusion
When people are cautioned to maintain a healthy lifestyle they usually think it is solely to prevent obesity or heart disease. Most people do not realize that our eyes are as dependent on our life choices as other organs in the body. As we age a natural plaque begins to form in our arteries just as plaque forms on our teeth if we don’t brush them. This happens to everybody but only escalates into a problem if the amount of plaque creates a loss of elasticity and hardens onto the arterial wall. These deposits are made up of calcium cholesterol or fatty tissue and eventually may cause a blockage of the inner wall of the artery. The following risk factors increase the production of plaque along the arterial wall:
- family history of artery hardening (atherosclerosis)
- high cholesterol
- high blood pressure
A complication with heavy plaque build-up is the potential for “debris”; some hardened pieces of plaque get knocked off the wall by flowing blood and then enter into the bloodstream.
A branch retinal artery occlusion (BRAO) occurs when one of the smaller arteries branching off the central retinal artery is blocked by a clot or debris (emboli). The debris most often originates in the carotid artery and sometimes from a heart clot. When the debris lodges in the arterial branch oxygen is effectively cut off causing visual loss in that area of the retina. Often a patch of retina loses some of its visual function and part of the field of vision may become darkened. The retina is the light-sensitive layer of tissue that lines the back of the eyeball sending visual impulses through the optic nerve to the brain. The retina plays a very important role in the eye and as such it requires a lot of blood to function properly. When it is deprived of it even for a short period of time it’s likely that vision damage incurred during the occlusion is permanent.
BRAOs are a medical emergency and most commonly occur in people between 50 and 80 years old. There is often a history of systemic illness like hypertension heart valve abnormalities carotid artery disease or diabetes. Vision in the affected area is usually severely blurred and lights appear much dimmer. Some people report feeling a shade or curtain covering part of their vision.
Currently treatment options are few and usually unsuccessful. Unless the occlusion can be diagnosed and treated in the first couple of hours some visual loss is likely. All treatments attempt to soften the eye (and reduce the pressure) so that normal blood flow may push the clot out of the way. Emergency treatments include medication massage of the eye or a tiny needle puncture into the eye to drain away aqueous fluid. Anyone who has had a BRAO is at an increased risk for stroke and heart attack. For this reason and to prevent further damage it is imperative to determine whether there is underlying carotid or cardiovascular disease. On the positive side doctors are looking into laser surgery and how it may help rectify retinal damage and fix the visual impairment caused by the occlusion.