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This 64YO male presented with one year of decreased vision in his left eye. Vision was 20/20 in his normal OD and 20/200 OS.
Optos color RGB imaging shows sheathing and ischemia throughout the posterior pole, sparing the superotemporal quadrant. Collateral vessels are noted on the nerve. Triton swept-source OCT shows diffuse inner retinal thinning with disorganization of inner retinal layers (DRIL) and a variably adherent epiretinal membrane. Fluorescein angiography shows profound retinal ischemia throughout the distribution of the hemiretinal vein occlusion (HRVO) with innumerable buds of retinal neovascularization. Collateral vessels cross the temporal horizontal meridian.
Learning Points:
Branch retinal vein occlusions are virtually always caused by a retinal artery compressing a retinal vein within its common adventitial sheath. Some people are born with an anomalous two-trunked central retinal vein that independently drains the superior and inferior retinal hemispheres. HRVO, similar to central retinal vein occlusion, is caused by compression of the retinal vein posterior to the lamina cribrosa (see Hayreh, Arch Ophthalmol 1980;98:1600-1609).
HRVO-related macular edema and retinal neovascularization are treated similarly to branch retinal vein occlusion. In 1986, the Branch Vein Occlusion Study Group reported that scatter laser decreased the risk of vitreous hemorrhage from retinal neovascularization in BRVO and suggested applying laser once neovascularization develops (Arch Ophthalmol 1986;104:34-41). We scheduled this treatment for our patient.
J Vitreoretin Dis. 2026 Jun 19:24741264261442916. doi: 10.1177/24741264261442916.
nAMD worse social deprivation index associated with worse VA outcomes despite similar baseline VA and treatment exposure — Retrospective, cohort, 643 patients
Purpose: To evaluate whether disease severity at diagnosis and treatment outcomes in patients with neovascular age-related macular degeneration (nAMD) may be stratified by the Social Deprivation Index (SDI; a measure of socioeconomic status [SES] where higher scores indicate greater socioeconomic deprivation).
Methods: We conducted a retrospective cohort study of 643 adults with newly diagnosed unilateral nAMD who were treated with antivascular endothelial growth factor (anti-VEGF) therapy at the Retina Group of Washington. Data collected included best-corrected visual acuity (BCVA) at baseline and 12 months, presence of submacular hemorrhage, and injection frequency in the first year of treatment. Logistic regression was used to assess associations between SDI and BCVA outcomes.
Results: A higher SDI score was associated with lower odds of achieving a BCVA of ≥20/40 at 12 months (odds ratio, 0.69, 95% CI, 0.48-0.98; P = .039). Submacular hemorrhage and non-White race were predictive of poorer outcomes, whereas sex at birth was not predictive. The number of anti-VEGF injections received over 12 months was similar between the high SDI quantile group and low SDI quantile group (mean 9.1 vs 8.8; P = .053). Age, baseline BCVA ≥20/40, and race were significant predictors of achieving a BCVA ≥20/40 at 12 months. BCVA at baseline was not significantly different between the SDI quantile groups, suggesting that disparities emerge during treatment rather than at diagnosis.
Conclusions: The SDI is a useful metric of social determinants of health in patients with nAMD. Higher SDI was associated with poorer visual outcomes despite similar baseline vision and treatment exposure, suggesting that disparities extend beyond diagnosis to treatment effectiveness. These findings underscore the multifactorial nature of socioeconomic influences, including race, treatment adherence, and access, and the need for targeted strategies to improve equitable care.
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