December 4, 2009

Trial tests treatments for retinal vascular blockage

Trial tests treatments for retinal vascular blockage

Retinal vein occlusion is the second most common retinal vascular condition in the United States and one of the most common causes of blindness.

Vanderbilt Eye Institute took part in a multi-center trial pitting standard treatment against steroid injection therapy for two forms of retinal vascular blockage. Central retinal vein occlusion (CRVO) occurs when a blood clot slows or stops circulation in a large vein, while branch retinal vein occlusion (BRVO) occurs in a smaller vein.

The study, Standard Care versus Corticosteroid for Retinal Vein Occlusion (SCORE), was divided into two trials to evaluate the most effective treatment for each condition.

Until recently, ophthalmologists had to watch as many patients with CRVO lost their vision because there was no treatment.

The CRVO trial compared standard treatment, consisting of observation, with eye injections of a corticosteroid medication called triamcinolone.
The study, published in the Archives of Ophthalmology, found that the steroid injections improved vision.

“Now we have demonstrated that for CRVO, steroid injections significantly improved their outcome,” said Paul Sternberg, M.D., chair of

Paul Sternberg, M.D.

Paul Sternberg, M.D.

Vanderbilt Eye Institute

“This is a significant step forward. We commonly see patients with the more severe form of retinal vascular occlusive disease, for whom we had no effective treatment. Although some would get better spontaneously, others would worsen.

“Patients would come in and I could examine their eyes and predict which direction their disease was going based on the severity of the blockage. However, I had no effective treatment for those with the grave prognosis.”
Sternberg served as the principal investigator for the SCORE trials.

In the BRVO study, clinicians were able to compare the effectiveness of standard therapy — laser treatment — with the same steroid injections. In this case, the steroid treatment did not prove superior to the standard treatment.

According to this study, patients who received laser treatments in a grid or checkerboard pattern experienced a lower rate of complications, while patients who received the steroid injections showed a higher rate of developing cataracts or increased eye pressure, which required medication.

“This kind of study raises an important reminder that as providers, we cannot assume, based on anecdotal experience, that a treatment would be favorable for multiple conditions,” said Sternberg. “Before we jump to adopt a new treatment, it is best to subject it to a well controlled, randomized study. In the case of these SCORE trials, the same treatment was effective for one condition but not for another.”

VEI is the only center in the region that participated in the study.