Keeping an Eye on Advances: The Evolving Treatment of Retinal Vein Occlusion

Anti-vascular endothelial growth factor (anti-VEGF) therapy remains the foundation of treatment for retinal vein occlusion (RVO)–related macular edema, delivering meaningful visual improvement and reductions in retinal swelling for many patients. However, the need for frequent intravitreal injections over prolonged periods continues to drive interest in therapies that maintain efficacy while reducing treatment burden.

Ranibizumab and aflibercept are established anti-VEGF agents used to manage macular edema secondary to RVO. These therapies act by inhibiting VEGF-mediated vascular leakage, thereby reducing macular edema and stabilizing or improving vision. While effective for many patients, their use typically requires repeated injections—often monthly—over many months or years. This frequent treatment schedule contributes substantially to patient burden, challenges with adherence, and long-term healthcare costs, particularly for individuals with limited mobility or access to care.

Corticosteroid therapy represents an alternative approach within current clinical practice. Steroid-based sustained-release implants, such as the dexamethasone implant, are designed to reduce retinal swelling by slowly releasing medication over several months. These implants help mitigate the fluctuations in drug exposure associated with single injections and can provide more durable control of macular edema in selected patients. Ongoing monitoring is required due to known risks associated with corticosteroids, including elevated intraocular pressure and cataract formation.

Beyond existing therapies, significant research efforts are focused on next-generation drug-delivery technologies aimed at extending the duration of treatment effect within the eye. Sustained-release platforms—including polymer-based implants and refillable reservoir systems—are being developed to maintain therapeutic drug levels for three to six months or longer. By minimizing the “peak and trough” effects of conventional injections, these approaches seek to reduce injection frequency while preserving anatomic and functional outcomes.

Innovative investigational strategies are also emerging. Gene-based therapies aim to enable retinal cells to produce therapeutic anti-VEGF proteins continuously following a single administration, potentially eliminating the need for repeated injections. Delivery methods under investigation include subretinal and suprachoroidal approaches. In parallel, researchers are exploring neuroprotective agents intended to preserve retinal nerve cells from ischemic damage, as well as highly experimental surgical techniques designed to address the venous occlusion itself rather than only its downstream effects.

Collectively, these sustained-delivery systems, biologic innovations, and experimental interventions reflect a concerted effort to address the limitations of current RVO management. The overarching goal is to achieve durable visual and anatomic benefits while substantially reducing treatment burden and improving long-term patient outcomes.