This month we will talk about retinal arterial macroaneurysms (RAM).

What is a retinal macroaneurysm?

Macroaneurysms are focal enlarged areas of an artery in the retina. This usually affects older patients, women more than men, and has a strong association with chronic high blood pressure.

What are the symptoms?

Many patients do not have any symptoms. If the macroaneurysm bleeds or causes fluid to accumulate in the macula, patients may have blurry or distorted vision. Floaters may occur if there is bleeding in the vitreous (the space in the back of the eye filled with gel).

How is it detected?

A comprehensive exam including checking the vision and dilating the eyes to view the retina are imperative. Optical coherence tomography, OCT, is a photo that shows if fluid or blood have accumulated in the layers of the macula. A fluorescein angiography may be done to show the microaneurysm more clearly. This test involves injecting a dye into the blood vessel in the arm to take pictures as the dye travels through the bloodstream.

The following photo shows the macroaneurysm with surrounding blood in the retina.

Retinal Arterial Macroaneurysms. Image Source ¹

What are the treatments?

Most retinal arterial macroaneurysms resolve on their own without treatment. Patients should see their primary doctor to check for high blood pressure. If there is a rupture, this is monitored closely for several months. Proper control of the blood pressure may lower the risk of macroaneurysm rupture. Laser and eye injections have been used to treat the bleeding and fluid from a rupture.

Return next month for a discussion on a new topic!