title: Optimal Treatment of Retinal Vein Occlusion: Canadian Expert Consensus.
abstract: BACKGROUND
  The availability of new therapeutic approaches, particularly intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapies, has prompted significant changes to the established treatment paradigms for retinal vein occlusion (RVO). Better visual outcomes and significantly lower rates of adverse events have been noted in multiple large randomized clinical trials and have led to a new standard of care for this sight-threatening condition.
  
  
  OBJECTIVE
  To develop an expert consensus for the management of RVO and associated complications in the context of recent clinical evidence.
  
  
  METHODS
  The development of a Canadian expert consensus for optimal treatment began with a review of clinical evidence, daily practice, and existing treatment guidelines and algorithms. The expert clinicians (11 Canadian retina specialists) met on February 1, 2014, in Toronto to discuss their findings and to propose strategies for consensus.
  
  
  RESULTS
  The result of this expert panel is a consensus proposal for Canadian ophthalmologists and retina specialists treating patients presenting with RVO. Treatment algorithms specific to branch and central RVO (BRVO and CRVO) were also developed.
  
  
  CONCLUSIONS
  The consensus provides guidelines to aid clinicians in managing RVO and associated complications in their daily practice. In summary, laser remains the therapy of choice when neovascularization secondary to RVO is detected. Adjunctive anti-VEGF could be considered in managing neovascularization secondary to RVO in cases of vitreous hemorrhage. Intravitreal anti-VEGF should be considered for symptomatic visual loss associated with center-involving macular edema on optical coherence tomography. Patients with BRVO and a suboptimal response to anti-VEGF could be treated with grid laser, and those with CRVO and an inadequate response to anti-VEGF may be candidates for intravitreal steroids.
authors.affiliation: University of Toronto, Toronto, Ont., Canada.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Berger
authors.forename: Alan F
authors.initials: AF
authors.lastname: Cruess
authors.forename: Filiberto
authors.initials: F
authors.lastname: Altomare
authors.forename: Varun
authors.initials: V
authors.lastname: Chaudhary
authors.forename: Kevin
authors.initials: K
authors.lastname: Colleaux
authors.forename: Mark
authors.initials: M
authors.lastname: Greve
authors.forename: Amin
authors.initials: A
authors.lastname: Kherani
authors.forename: Efrem D
authors.initials: ED
authors.lastname: Mandelcorn
authors.forename: Hugh
authors.initials: H
authors.lastname: Parsons
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Rhéaume
authors.forename: Eric
authors.initials: E
authors.lastname: Tourville
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D002170:Canada; D032921:Consensus; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D012170:Retinal Vein Occlusion / Q000503:physiopathology / Q000628:therapy*; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors