Retinal Vein Occlusion Treatments: 6 Essential RVO Medications You Should Know About
Key takeaways:
Retinal vein occlusion (RVO) refers to a blockage of blood flow in the eye. It can lead to vision changes and potential vision loss.
Injectable vascular endothelial growth factor (VEGF) inhibitors and corticosteroids (“steroids”) can help improve vision problems from RVO. They do so by reversing unwanted blood vessel formation, leaky vessels, and swelling in the eye.
VEGF inhibitors, such as Lucentis, are preferred over steroids for RVO because they’re generally more effective. Steroids may be a better choice for people who can’t receive monthly injections or don’t tolerate VEGF inhibitors well.
Table of contents
Did you know that blood flow to your eye plays a big role in keeping your vision sharp? Your retina contains a lot of blood vessels that transport blood and vital nutrients to the eye. But it’s just as important that blood gets carried away after it has done its job.
Your retinal vein has the important job of draining blood away from the eye so it can have a fresh supply. But this vein can sometimes get blocked. This is known as a retinal vein occlusion (RVO). RVO can cause swelling inside the eye, leading to blurry or decreased vision.
RVO can happen in the small vessels that attach to the retinal vein. This is called branch retinal vein occlusion (BRVO). Blockages can also happen in the retinal vein itself, which is better known as central retinal vein occlusion (CRVO).
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Thankfully, several treatments are available to reverse this process. Let’s take a closer look at six RVO medications you should know about if you’ve been diagnosed with this condition.
1. Lucentis
Lucentis (ranibizumab) is an injection that you receive in your eye once a month. It’s a type of vascular endothelial growth factor (VEGF) inhibitor. Lucentis blocks VEGF-A — a protein involved in the growth of new blood vessels.
When retinal veins are blocked, your body will sometimes compensate by growing new blood vessels. But these unwanted blood vessels can damage the eye and lead to leaky vessels, eye swelling, and vision problems. By blocking VEGF-A, Lucentis helps improve your vision.
Studies suggest that if you have BRVO, Lucentis can increase your ability to read up to an average of 18 new letters (or 3.5 additional lines) on an eye chart. This is compared to an increase of 7 letters in people who don't receive it. For people with CRVO, Lucentis injections can increase their ability to read letters on an eye chart by 15 letters on average.
The most common Lucentis side effects are eye redness and pain, eye floaters, and increased eye pressure. It’s normal to have mild eye-related symptoms like these for a few days after your injection. In rare cases, Lucentis can cause retinal vein inflammation and retinal detachment. Another rare complication is endophthalmitis, an infection inside of your eyeball.
Lucentis biosimilars
Two Lucentis biosimilars are FDA approved for macular edema (eye swelling) from RVO. Biosimilars are biologic medications that are highly similar to an originally approved medication.
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Byooviz (ranibizumab-nuna) was approved in September 2021, and Cimerli (ranibizumab-eqrn) was approved in August 2022. The only difference between the two is that Cimerli is an interchangeable biosimilar. Meaning, in some states, pharmacists can substitute it for Lucentis without prescriber approval.
2. Eylea
Eylea (aflibercept) is another VEGF inhibitor that’s given in the eye once a month. Eylea blocks the action of VEGF-A and a related protein called placental growth factor (PlGF). This makes it slightly different from other VEGF inhibitors. Blocking PlGF is another way to hinder unwanted blood vessel growth.
In a clinical study, Eylea increased the ability to see at least three additional lines on an eye chart in over half of people with CRVO. Only about 1 in 10 people who received placebo injections had this increase. Another study had similar findings.
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Eylea’s side effects are similar to Lucentis.
Good to know: Eylea is also available as Eylea HD. HD stands for “high dose” and this version is meant to be given less often than the standard version. However, Eylea HD isn’t approved for RVO yet.
Eylea biosimilars
Two Eylea biosimilars were approved in May 2024: Yesafili (aflibercept-jbvf) and Opuviz (aflibercept-yszy). Both are interchangeable biosimilars that are approved for RVO.
3. Vabysmo
Vabysmo (faricimab) is the newest VEGF inhibitor. It was approved for RVO in October 2023.
Vabysmo is another monthly eye injection. But Vabysmo sets itself apart because it’s a bispecific antibody. This means it uses just one antibody to block two different proteins: VEGF-A and Ang-2. Ang-2 is a non-VEGF protein that leads to unwanted blood vessel growth, leaky vessels, and too much fluid in the eye. By comparison, Eylea is only able to attach one protein at a time.
In two clinical studies, monthly Vabysmo injections were comparable to Eylea injections. However, Vabysmo was more effective than Eylea at preventing fluid leakage in the eye.
The most common Vabysmo side effects are cataracts — a breakdown of proteins in the eye that cause cloudiness and vision changes — and bleeding in the eye. Vabysmo has the same rare side effect risks as Lucentis and Eylea.
4. Avastin
Avastin (bevacizumab) is an older VEGF inhibitor. It was originally approved in 2004 and now treats many forms of cancer. Avastin isn’t officially approved for RVO, but it’s often used off-label for this purpose. It’s given as a monthly eye injection.
Ophthalmologists started experimenting with Avastin eye injections while waiting for Lucentis to be approved. Small studies found that Avastin eye injections helped improve vision and were well tolerated. Many ophthalmologists still choose to use Avastin today because it’s typically cheaper and just as good as other VEGF inhibitors.
Avastin side effects, including rare side effects, are comparable to other VEGF inhibitors.
Avastin biosimilars
There are currently five approved Avastin biosimilars. These include:
Alymsys (bevacizumab-maly)
Avzivi (bevacizumab-tnjn)
Mvasi (bevacizumab-awwb)
Vegzelma (bevacizumab-adcd)
Zirabev (bevacizumab-bvzr)
Since Avastin isn’t approved for RVO, none of the biosimilars are either. Your prescriber probably won’t use Avastin biosimilars for RVO unless information becomes available confirming they’re safe for use in the eye.
5. Triamcinolone
Triamcinolone was the first injectable eye medication used to treat swelling from RVO. It’s a corticosteroid (“steroid”) that blocks VEGF and decreases inflammation.
Like Avastin, triamcinolone is used off-label for RVO. Some ophthalmologists use the brand Kenalog-40. Others prefer a compounded, preservative-free version called triamcinolone acetonide. Compounded medications are custom-made by certain pharmacies.
The best triamcinolone dose hasn’t been established for RVO. But it's typically given once every 4 months. Triamcinolone increases the ability to see at least 3 additional lines on an eye chart in almost 30% of people with CRVO.
Steroid eye injections increase the risk for cataracts, glaucoma, and increased eye pressure.
6. Ozurdex
Ozurdex (dexamethasone) is an injectable steroid implant for RVO that’s placed in the back of the eye. It’s biodegradable, so the implant slowly dissolves on its own without the need for surgical removal. It’s typically given every 3 to 5 months, although some people only need a one-time implant.
In clinical studies, Ozurdex increased the ability to read at least 3 additional lines on an eye chart in more than 20% of people who received the implant.
Ozurdex may be a good choice if you aren’t benefitting from VEGF inhibitors or you don’t have enough fluid in the back of your eye to absorb the other eye injections. It’s also a good option if you’ve responded well to triamcinolone in the past but had to stop it due to increased eye pressure.
Potential Ozurdex side effects include increased pressure in the eye and cataracts. Rare side effects, such as endophthalmitis, can also occur.
What is the best retinal vein occlusion treatment?
There is no best treatment for RVO. Your ophthalmologist should consider your medical background, treatment logistics, and cost to determine which is best for you.
In many cases, you’ll likely be offered a VEGF inhibitor as your first RVO treatment. They’re more effective than steroids and can help you avoid side effects such as cataracts and increased eye pressure.
What’s more, off-label VEGF inhibitors (such as Avastin) are often more affordable than approved RVO injections. Your ophthalmologist may prefer an off-label VEGF inhibitor for this reason alone. They may also prescribe VEGF inhibitors and steroids together to decrease the frequency of your injections.
Can retinal vein occlusion be cured?
Unfortunately, no. RVO typically requires ongoing treatment and monitoring. However, most people continue to see benefits for at least 5 years after starting treatment.
The bottom line
Retinal vein occlusion (RVO) can lead to vision changes and vision loss. Injectable vascular endothelial growth factor (VEGF) inhibitors and corticosteroids (“steroids”) can improve vision by reversing unwanted blood vessel formation. They can also help fix leaky vessels and swelling in the eye.
VEGF inhibitors such as Lucentis are preferred over steroids because they’re typically more effective. Steroids may be a better choice in people who can’t receive monthly injections or don’t tolerate VEGF inhibitors. Some people may end up receiving both medications to manage their RVO.
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References
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