Question for the resident ophthalmologists?!


Question: age related wet Macular Degeneration, is the treatment with lucentice for the rest of someones life, or can it be stopped after a year or so.
reason I ask this is, I am a American living in south east Asia, suffer from the disease, and will return to the states for about a year, would it be worth while for me to start the treatment.?


Answers: age related wet Macular Degeneration, is the treatment with lucentice for the rest of someones life, or can it be stopped after a year or so.
reason I ask this is, I am a American living in south east Asia, suffer from the disease, and will return to the states for about a year, would it be worth while for me to start the treatment.?

The use of anti-VEGF agents such as Lucentis, or Avastin, or a combination steroid, anti-VEGF agent, with our without PDT treatment has been a blessing for macular degeneration patients. The statistics show that in patients with certain types of macular disease, those agents can help one gain a certain amount of vision as measured by the number of letters gained over a period of time.

With monthly injections, Lucentis helps maintain that vision gain. When the injections were slowed to quarterly injections, vision gains were lost by the 8th month, back to pre treatment levels. The ANCHOR and other studies show these types of results.

BUT...
If you have monthly injections of Avastin, for instance, it doesn't take all that long for you to develop a resistance. As part of the disease is inflammatory, we now use combination therapies that may include Decadron, to inhibit that portion of the disease progression. Lucentis is the whole antibody, Avastin the haptomer, yet still the resistance develops. No matter how we address the issue, you need to have frequent OCT studies to show the difference in macular thickness, where the fluid is located, whether or not you've developed an RPE tear, whether or not blood is present, presence of fluid or exudate or ?

If you have an active disease, start the treatment. You'll be better off at the end of the year, and may have saved yourself a vision loss you'd be otherwise trying to make up when newer therapies may be available by then as well.

Laser Rx is destructive. If you do not have a central lesion, and the membrane is not in the MP bundle area, laser may be a better choice. PDT therapy does kill the active vessels at the time of the therapy, but within a few months or so, new vessels will grow. We're going to find that multiple therapies will be the best way to go, and changing medications to VEGF traps, along with PDT, anti-VEGF medications, as well as anti-inflammatory treatments will help people maintain useful vision for longer and longer periods of time., and minivitrectomies are now being considered along with the soups mentioned above as an adjunct to these types of Rx.

As in HIV patients, it won't be that long before we have implants that slowly leak different types of anti-VEGF agents or VEGF traps or steroids into the eye and so avoid the risks of monthly injections...which include retinal detachments, endophthalmitis, etc...

YES! I am not an Opthamalogists but the wet kind is the one you really need to take care of it urgently. If you don't start treatment you will get a lot of permanent eye damage and lose vision acuity. There are laser surgeries that can seal the leakage but you might need retreatment after a while.

Lifelong. Initial therapy is montly injections for several months then injections as needed every 2-6 months. You should be able to get follow up injections in SE Asia.





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