Retinal Vein Occlusion: Why Anti-VEGF Injections Keep Wearing Off — And How Chinese Medicine Can Realistically Help

Traditional Chinese medicine categorises RVO as what classical texts call 络瘵暴盲 — sudden vision loss from obstruction of the retinal collaterals.

Despite using a very different language, Chinese medicine is still able to explain the underlying  mechanisms in a way we all understand: blood not moving properly, accumulating where it shouldn’t, obstructing light.

What is important in Chinese medicine is that we decide what pattern you are exhibiting. And in RVO, clinical differentiation accurately describes different types of body types.

1. Liver qi stagnation leading to blood stasis. This would be stress and overwhelm resulting in a circulatory issues.

2. Spleen deficiency failing to hold blood within the vessels. This is the chronically deficient person who needs some herbal support.

3. Liver-kidney yin deficiency with ascending yang. This maps reasonably well onto the hypertensive patient with chronic vascular dysregulation.

More practically, the treatment is staged according to where the patient is in the disease timeline:

1. In the early phase — active bleeding, early hemorrhage — the priority is cooling blood and arresting bleeding. We prefer to stay out of the way here, but acupuncture at this stage is safe and is good at reducing acute inflammation locally.

2. In the middle phase — hemorrhage stabilised, macular edema prominent — the approach shifts to moving blood and resolving stasis. There are also herbs that can help with macular edema Peri-ocular acupuncture is always useful here..

3. In the late phase — hemorrhage reabsorbed, visual function the priority — the treatment focuses on supporting kidney and liver function for sustained recovery, and addressing epiretinal membrane formation with phlegm-resolving herbs if needed.

Based on clinical cases treated with this framework, the strongest evidence is in three areas.

1. Hemorrhage absorption.

This is where the staged herbal approach seems most consistent. The sequential shift from cooling blood to activating blood movement mirrors what we know about how hemorrhage resolves physiologically — and appears to accelerate it.

2. Macular edema recurrence prevention.

This is the most clinically important finding. The pattern seen repeatedly is: anti-VEGF controls acute edema well, but edema recurs as soon as the drug effect wanes.

After the acute phase is over, the use of TCM herbs can help to extend the edema remission period. The working hypothesis is that constitutional treatment of the underlying vascular pattern — rather than suppressing a single molecular signal — produces more durable stability.

3. Systemic risk factor management. 

This is underappreciated. The same risk factors that caused your RVO — hypertension, hyperlipidemia, metabolic imbalance — will drive the recurrence and eventually affect your other eye.

Chinese medicine’s constitutional approach addresses these systemically, not just as background noise. Herbal formulas, diet and lifestyle modifications are all standard components of treatment. This is where the integrative model adds something an ophthalmologist, managing injections in a busy clinic, rarely has time for.

For acute macular edema with significant, rapid vision loss, anti-VEGF works faster than anything else. This is especially so with ischemic CRVO. Waiting several weeks for herbs to take effect is a real risk when central vision is acutely threatened.

The practical model here is anti-VEGF for acute control, then TCM to extend the remission and reduce injection frequency over time. These are not competing approaches. They address different timelines of the same disease.

For non-ischemic BRVO with moderate vision loss, TCM has a more independent role. The natural history of non-ischemic BRVO is better, anti-VEGF injections are not always urgently indicated. This is where TCM show the most consistent results.

If you develop neovascular glaucoma (new vessels growing on the iris, rising eye pressure, pain), this is an emergency. Anti-VEGF injection and laser photocoagulation are required. There is no herbal substitute for this.

If you develop traction retinal detachment from fibrovascular proliferation, you need vitreoretinal surgery.

If there is a dense vitreous hemorrhage obscuring the fundus, vitrectomy may be necessary. Some hemorrhages do resolve on their own, but this is a conversation to have with your  ophthalmologist based on your imaging results.

The honest position is that TCM works best in patients who are past the acute emergency phase, who have a stable fundus under ophthalmological monitoring, and who are looking to reduce recurrence and support long-term recovery. It should always be pursued with continued monitoring — OCT, visual acuity, fundus photography at appropriate intervals.