Branch Retinal Vein Occlusion (BRVO): Symptoms, Diagnosis & Treatment in Birmingham

BRVO occurs when a branch retinal vein—usually at a point where it crosses an artery—becomes blocked, preventing blood from draining from that section of the retina. This blockage causes blood and fluid to leak into the retina, resulting in haemorrhages, swelling (macular oedema), and vision loss.

Unlike CRVO, which affects the entire retina, BRVO impacts only the section of retina drained by the blocked vein—typically one quadrant (often the superior or inferior temporal region). ​

BRVO is more common than CRVO and usually affects people over 60, particularly those with high blood pressure, diabetes, or atherosclerosis.

Most BRVOs occur at arteriovenous crossings where a retinal artery and vein share a common connective tissue sheath.

When the artery hardens (atherosclerosis), it compresses the adjacent vein, narrowing the blood flow and causing turbulent flow that promotes clot formation. This leads to a blockage (occlusion) that prevents blood drainage and causes fluid leakage and macular oedema.

​Risk factors include:

• High blood pressure (hypertension)
• Diabetes
• Atherosclerosis (hardened arteries)
• Smoking
• High cholesterol
• Glaucoma

BRVO typically causes sudden, painless vision changes in one eye :​

• Blurred or distorted central vision

• Dark patch or blind spot in one area of vision (visual field defect)

• Difficulty reading or recognising faces

• Straight lines appearing bent or wavy

If the affected area is peripheral (away from central vision), BRVO may go unnoticed initially and be detected only during a routine eye exam.​

In rare cases, undetected BRVO can lead to new abnormal blood vessels (neovascularisation), which may cause floaters from vitreous haemorrhage.​

If you notice sudden vision loss or visual field changes, seek urgent assessment. Early treatment significantly improves visual outcomes.

Mr. Sahota uses comprehensive imaging and examination to confirm BRVO, determine severity, and guide treatment:

Dilated Fundus Examination: Identifies the characteristic wedge-shaped pattern of retinal haemorrhages, cotton-wool spots, dilated tortuous veins, and macular oedema in the affected retinal quadrant.​​

OCT (Optical Coherence Tomography): Measures central macular thickness and quantifies fluid (macular oedema) to determine treatment urgency and monitor response.​

OCT Angiography (OCT-A): Maps retinal blood flow without dye injection, identifying areas of capillary non-perfusion (ischaemia) that influence prognosis and treatment decisions.​

Risk factor assessment includes checking blood pressure, blood sugar levels, cholesterol, and cardiovascular health.

The primary goal of BRVO treatment is to reduce macular oedema and preserve central vision. Treatment decisions are guided by clinical trials demonstrating significant visual benefit.​​

Anti-VEGF Injections

Anti-VEGF drugs are the first-line treatment for macular oedema secondary to BRVO.​​

How it works: When a retinal vein is blocked, the retina releases VEGF (vascular endothelial growth factor), causing blood vessels to leak fluid. Anti-VEGF drugs block this protein, reducing macular swelling and improving vision.​​

Available agents:

• Eylea (aflibercept)

• Vabysmo (faricimab)

• Lucentis (ranibizumab)

Evidence: The landmark BRAVO trial showed that ranibizumab (0.5mg) produced a mean gain of +18.3 letters at 6 months in BRVO patients, with 61% gaining 3 or more lines on the eye chart.​​

The VIBRANT trial demonstrated that aflibercept (Eylea) achieved similar results with a mean gain of +17 letters at 6 months.​

The recent BALATON trial showed that faricimab (Vabysmo) achieved +17 letter gains, comparable to Eylea, with potential for extended dosing intervals.​

Treatment schedule: Typically begins with monthly injections for 3-6 months (loading phase), followed by individualised maintenance dosing—often every 8-12 weeks—based on OCT findings and visual response.​​

BRVO often requires fewer injections than CRVO, with many patients achieving stable vision after the loading phase.​

Ozurdex Steroid Implant

Ozurdex (dexamethasone intravitreal implant) is an alternative treatment that provides sustained steroid release over 4-6 months.​

How it works: The tiny implant is injected into the eye and gradually releases dexamethasone, a potent anti-inflammatory steroid that reduces macular swelling.​

Evidence: The GENEVA trials demonstrated that Ozurdex significantly accelerates visual improvement in BRVO, with shorter time to gain ≥15 letters compared to sham treatment.​

Who benefits: Ozurdex may be preferred for pseudophakic patients (those who have had cataract surgery), patients unable to attend monthly appointments, or those with insufficient response to Anti-VEGF therapy.​

Side effects: Ozurdex increases the risk of intraocular pressure elevation (approximately 16% of patients) and cataract formation in patients with natural lenses. Close monitoring is essential.​

Laser Treatment

Laser photocoagulation (grid laser) was historically used for BRVO, but Anti-VEGF injections have largely replaced it as first-line therapy due to superior visual outcomes.​​

Laser may still be used in specific cases to treat peripheral ischaemia or when injections are not suitable.​

Initial Assessment with Mr. Sahota

Your first appointment includes:

• Comprehensive medical and ocular history

• Visual acuity and visual field testing

• Dilated fundus examination

• OCT and OCT angiography imaging

• Discussion of treatment options tailored to your findings

Same-week treatment can often be arranged to begin reducing macular oedema as soon as possible.​

Loading Phase (Months 1-4)

Anti-VEGF pathway: Monthly injections for the first 3-4 months with OCT monitoring at each visit. Vision typically begins improving within the first 2-4 weeks, with maximum benefit by 6 months.​​

BRVO often responds more rapidly and requires fewer injections than CRVO.​

Ozurdex pathway: Single implant provides 4-6 months of steroid release. Repeat implants may be given as fluid recurs.​

Maintenance Phase (Beyond 6 Months)

As macular oedema stabilises, injection intervals are gradually extended based on OCT findings. Many BRVO patients achieve stable vision with injections every 3-4 months, and some patients can stop treatment altogether if the retina remains dry.

BRVO generally has a better prognosis than CRVO. Many patients experience significant vision improvement with treatment.​​

With Anti-VEGF treatment: Approximately 60% of BRVO patients gain 3 or more lines on the eye chart at 6 months, with mean improvements of 17-18 letters.​​

Spontaneous improvement: Approximately 30% of untreated BRVO patients experience some natural improvement as collateral vessels develop, though treatment accelerates and maximizes visual recovery.​​

Complications: The main risk in untreated BRVO is neovascularisation, which can cause vitreous haemorrhage or neovascular glaucoma in severe ischemic cases. Anti-VEGF therapy significantly reduces this risk.​

Early diagnosis and treatment with consultant-led care offer excellent chances of preserving functional vision.​

Private BRVO treatment costs in Birmingham depend on the drug used, injection frequency, and facility fees. For detailed pricing information including consultation fees, imaging costs, and per-episode totals, see our dedicated BRVO treatment cost guide.

Birmingham Clinics for BRVO Care

Mr. Sahota provides expert BRVO diagnosis and treatment at:

Edgbaston Eye Consultants: 22 George Road, Edgbaston, Birmingham B15 1PJ

The Westbourne Centre: 53 Church Road, Edgbaston, Birmingham B15 3SJ

Both clinics offer convenient access from Solihull, Sutton Coldfield, Harborne, and throughout the West Midlands, with flexible appointment times and online booking.

Is BRVO an emergency?

Not an ophthalmic emergency but it is an urgent problem — sudden vision loss from BRVO requires assessment urgently as early treatment significantly improves visual outcomes. Contact the clinic immediately for same-day triage and treatment where appropriate.

How many injections will I need? 

Most BRVO patients require monthly injections for 3-4 months initially, followed by individualised maintenance—often every 8-12 weeks. BRVO typically requires fewer injections than CRVO.

Can BRVO affect my other eye?

BRVO usually affects only one eye but yes it can be a bilateral condition. The risk of developing BRVO in the second eye is low, though managing risk factors like blood pressure and diabetes reduces this risk further. ​

Will BRVO come back after treatment?

The treatment is not curative. Most BRVO cases stabilise with treatment, though macular oedema can recur, requiring re-treatment. Regular monitoring with OCT ensures prompt re-treatment when needed.

What's the difference between BRVO and CRVO?

BRVO affects only part of the retina (one quadrant), while CRVO affects the entire retina. BRVO typically has better prognosis and requires fewer treatments than CRVO.

Can vision fully recover from BRVO? Many BRVO patients achieve excellent vision recovery with treatment. Approximately 60% gain 3 or more lines on the eye chart, with some patients recovering to near-normal vision.

Can private medical insurance cover BRVO treatment? Many PMI policies cover Anti-VEGF and Ozurdex for BRVO when medically indicated. Check your policy coverage and excess before starting treatment.

Schedule online for urgent BRVO assessment with Mr. Dilraj Sahota. 📞 Call +44 121 630 4580

This guide provides general educational information about branch retinal vein occlusion and does not replace personalised medical advice from a qualified clinician. Individual treatment requirements, prognosis, and costs vary based on BRVO severity, ischemic status, imaging findings, and medical history. A written treatment plan will be provided after consultation. If you experience sudden severe vision loss, seek urgent care immediately via emergency services or your nearest eye hospital.​

Last updated: January 2026