A couple of months ago, I examined a new patient who had been complaining of decreased vision, and distortion, in the right eye for about 2 months. His vision was 20/200 in the right eye. After examination, I recommended Avastin® treatment for his wet macular degeneration. This is his account of the injection and the weeks after.
Saturday, 12/5 I was administered the shot of Avastin at about 12:49 pm. I was first given about 4 Q-tips of topical anesthetic. The Avastin was then administered. I felt no pain when the needle entered, but I felt a not-too-s pressure. Soon thereafter, I suspect when the drug was “pushed’ out of the syringe, I did feel slight pain for about 1 second or so.. The fact that I felt some pain worried me, more that the slight pain itself, likely because of where and how I felt it….a NEEDLE in my EYE, knowing I couldn’t move. The pain disappeared immediately after about 1 second. After the needle was removed, I felt no pain whatsoever. Soon after leaving the office, I felt a significant irritation in my eye, similar to what one would experience with a more than mild seasonal allergy. There was slight burning, but NOTHING what one might say would approximate any kind of pain, For the next few hours it persisted, then it went away. Perhaps it was because of a post-procedure antibiotic. The rest of the day my eye was irritated, but nothing more that the feeling one might have when the eye is scratched when taking out a contact. I did feel some slight pressure/swelling of the eye afterwards, throughout the day, but, again, no pain. I went to bed at about 11:45 pm on Sat.
Sunday, 12/6 I woke up on Sunday at about 8:30, My eye felt normal. I did not have a contact lens in the subject eye since the night of Friday, 12/4. I looked in the mirror, and it visually appeared to look normal. I got my act together, then went downstairs. I closed my good eye, to see how the subject eye was performing. Without considering the distortion issue which brought me to Dr. Wong, the “clarity” of vision in that eye “seemed”, and “seems”, noticeably improved, without my contact in. Lines seem more defined and crisper.
As to the distortion, my sense is that it is already improved, although it is still definitely present. I note, however, that it seems less “bothersome” to me on a minute-by-minute basis. I am writing this shortly thereafter…at 9:36 a.m….only 21 hours after the procedure that administered the drug. It is possible that my perception is psychological, or that it is difficult to judge comparatively since my eye was irritated until I went to bed last night, but my “sense” is that the distortion is actually improved from the starting point. Overall I would rate my vision in the subject eye as already being better than before I underwent the procedure.
Monday, 12/7 Upon wakening this morning, and for 2 hours thereafter, I noticed no change in my vision from Sunday.
Tuesday, 12/8 I noticed no change in my vision an hour after my 6:00 a.m wake up
Wednesday 12/9 – 12/13 No discernable difference in my vision
Sunday 12/13 My impression is that there seems to be some slight improvement in the distortion, but it is not possible to accurately define.
Wednesday 12/15 I notice that I am able to read large type better than before, but small type is not possible. The distortion seems the same since yesterday
Saturday 12/19 In the shower this morning, I had the strong impression that my distortion is much better. There is still distortion, but it seems much less significant than before. When I close my left eye, there is what I feel is excellent clarity, but still some distortion.
Friday 1/1 I noticed in the shower that my distortion seems improved again. Things don’t seem as slanted with my right eye, as compared to my left eye (with right eye shut).
Friday 1/8 My impression is that the distortion is improved again, but it’s hard to explain “how”. I suppose, it’s just a bit less severe.
Wed 1/13 No discernible change…………
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Sat 1/23
Got another shot yesterday. They left the anesthetic on longer before the shot. I had no pain during the shot, but it was pretty uncomfortable. No big deal. The shot was quick. Had burning and watery eye for next 3 hours, then much better. Woke up this morning, and for the first ½ hour I forgot that I even had a shot yesterday.
Put the contact lens in about 9:30 am. All systems are go. Eye feels a touch tender, but a total non-issue.
I notice no change in my vision from before the shot yesterday.
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What Does This Mean? The second shot was administered last Friday. Vision had improved from 20/200 to 20/40 in just six weeks! In all the literature, you never read anything from the patient’s perspective. I find it interesting that my patient noted changes in the vision almost immediately and that these changes continued for the first month. A third injection is planned in another 6 weeks. I suspect that the vision will continue to improve, especially the distortion, based on the location of the neovascular tissue; it is just to the side of the macula. Once the nevascular tissue has regressed, additional injections may be needed for “maintenance.”
“Randy”
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
{ 4 comments… read them below or add one }
Very good patient perspective and rather simlar to my own experience. I have the Avastin for Macular Oedema but also have other problems affecting my vision, so any and all improvement I get following the injections is a bonus!
For me the actual injection is only momentarily painful when the needle breaks through. Plenty of local anaesthetic drops are used so I don’t get too much irritation afterwards. The only thing I find quite uncomfortable (not painful) is the placement of the speculum used to hold the eyelids open.
I do get some pain as a result of the increased pressure after the injections but I have other eye conditions that contribute to this.
I have had going on for nearly 30 injections over 2 years (in both eyes) and now note that the improvement for me is most evident from about 4 days after the injection. I have certain ways of checking the improvements, if I can read the clock face at the other side of the room, make out wind turbines on distant hills to just using the computer with less magnification.
I seem to have permanently lost the clarity for faces, road signs and license plates. Despite this, I have functional vision that still improves following the Avastin injections and I will continue having them as long as they do!
Having the injections is nothing to endure in comparison to the near miraculous improvement to my vision. When things began to go badly wrong and the macular oedema was severe I thought I would go blind. Thanks to Avastin I haven’t!
First off: Thanks for all the work you do for this site. I sincerely appreciate it.
I, too, have been receiving Avastin injections for the past 2+ years due to a macular edema in my left eye. (Please note: I have Best Disease in my right eye). Each are administered every 4 to 5 weeks. Some thoughts and comments.
The injections themselves are relatively painless. There is some pressure at times, depending on the anesthetic application/effectiveness. Given I have had about 23 injections so far, only about 2 of them would classify as painful. Pain like getting punched in the face. Short-lived, but seismic in its power – almost dizzying. I cannot see well out of the injected eye for the remainder of the evening (I do try to schedule my injections late in the day).
For my first 20 injections, they were administered at about the 6 O’clock part of my eye, and have since moved to the 10 O’clock position. It has made recovery so much smoother, though anesthesia application is not any easier, at all. The anesthesia application is absolutely brutal. Having someone hold a Q-tip to your eye for any period of time is uncomfortable, but for minutes at a time – horrendous. The worst part of it all!!!
The night of the shot, after the topical anesthesia wears off, is pretty uncomfortable. Akin to have something caught in your eye (for hours). Wetting drops, (along with the anti-biotic drops) come fast and furious. A sleeping pill has been a good friend those nights. Just makes it easier for a person who normally likes to sleep face down. The following morning brings a crusty eye to the mirror, but not bad at all. And it just gets better from there on out, thankfully.
My visual acuity has been pretty spotty as we approach each injection, the floaters and blurred vision increase. My ability to see small type is greatly diminished. Vision is relatively quite good the day after the shot. Within 2-3 days after the injection, I am seeing totally fine again. That lasts for about 4 weeks, before the deterioration sets in, then back for another shot.
I despise this process. It is not fun at all. Yet, my doctor’s staff makes it so much better than it could be. I have had many different people administer the anesthesia; some are much, much better than others. A little empathy goes a long way there. My doctor is the best, in so many ways. Honest, heartfelt caring and compassion makes an uncomfortable process, and scary subject (my vision) much, much better. I am very grateful and thankful for his care.
L,
Thanks so much for taking the time to comment. There are several readers who share the same perspective.
Cheers!
Randy
T,
Thank you so much for sharing your perspective. I have really this medium very much. Best of luck, thanks for contributing and please stay in touch!
Randy