Retinal vein occlusion: general work-up (and what not to order)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
General work-up requested by the ophthalmologist
Fasting laboratory tests
- FBCif needednon-French guidelineIrish hospital protocol (2022), which lists haematological diseases among the causes and differential diagnoses [2]; in the United Kingdom, measured as early as the ophthalmology visit [3]. The French treatise sticks to blood pressure, diabetes and lipids.
- Fasting plasma glucose (if no known diabetes)
- HbA1c (if known diabetes)if neededDiabetes must be looked for at diagnosis [4]; in known diabetes, HbA1c replaces fasting plasma glucose [2].
- Serum electrolytesif needednon-French guidelineSerum electrolytes, urea and creatinine requested from the GP by the Irish hospital protocol (2022) [2]; not cited by French texts.
- Serum creatinine with eGFRif needednon-French guidelineSerum electrolytes, urea and creatinine requested from the GP by the Irish hospital protocol (2022) [2]; not cited by French texts.
- Lipid profileif needednon-French guidelineHyperlipidaemia, a risk factor retained by the recommendations [4]; lipid profile requested by the Irish protocol [2] and lipid monitoring by the American Academy of Ophthalmology [5].
Do not order
- Routine thrombophilia screen (factor V Leiden, factor II mutation, protein C and S, antithrombin): these abnormalities are as frequent as in the general population in patients with retinal occlusion [8]; “Thrombophilia screening is not indicated” [2]; an abnormality changes neither management nor prognosis [4].
- Routine homocysteine: hyperhomocysteinaemia is no more frequent than in the general population [8] and only two recommendations propose it, in selected cases [4]. Homocysteine is not listed in the NABM [6].
- Antiphospholipid antibodies as a routine: no systematic testing, unless there is another element suggesting antiphospholipid syndrome [4,8].
Sources (8)
- Rogers S, McIntosh RL, Cheung N, Lim L, Wang JJ, Mitchell P, et al. The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology. 2010;117(2):313-9.e1.
- Royal Victoria Eye and Ear Hospital (Dublin). Clinical guideline for the treatment of suspected retinal vein occlusion. 2022.
- Nicholson L, Talks SJ, Amoaku W, Talks K, Sivaprasad S. Retinal vein occlusion (RVO) guideline: executive summary. Eye (Lond). 2022;36(5):909-912. (Résumé de la recommandation du Royal College of Ophthalmologists.)
- Galvez-Olortegui J, Bouchikh-El Jarroudi R, Silva-Ocas I, et al. Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion. Eye (Lond). 2024;38(9):1722-33. (Synthèse des recommandations du Royal College of Ophthalmologists 2022, d'EURETINA 2019, de l'American Academy of Ophthalmology 2019, de la SERV et du consensus canadien 2015.)
- Kovach JL, Bailey ST, Kim SJ, et al. Retinal Vein Occlusions Preferred Practice Pattern®. American Academy of Ophthalmology. Ophthalmology. 2025;132(4):P303-P343.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105.
- The Royal Victorian Eye and Ear Hospital (Melbourne, Australie). Clinical practice guideline: emergency department. Central retinal vein occlusion (CRVO). Version 3.0, approuvée le 08/06/2021.
- Romiti GF, Corica B, Borgi M, Visioli G, Pacella E, Cangemi R, et al. Inherited and acquired thrombophilia in adults with retinal vascular occlusion: a systematic review and meta-analysis. J Thromb Haemost. 2020;18(12):3249-66.