I am going to try something new. I am going to report on a patient with macular degeneration who did well with anti-VEGF therapy. It is a success story that I’d like to share. Of course, the names have been changed to protect the innocent……………….
About 3 years ago, a friend asked me to examine his 84 year old mother. She had lost the ability to read about 5 years prior and missed playing golf. She had had previous treatment for “macular degeneration” in one eye in New York. There was no other history.
After examining Mrs. X, I found that the left eye was lost to macular degeneration, that is, it had evidence of the wet form of the disease, but had already scarred over…………too late for any therapy at all. The right eye, also had signs of the wet form, but no signs of scarring (as some cuts on the skin develop a keloid, another form of scarring, the retina can also develop a similar reaction). There were signs that this had been going on for a long time.
My guess was that Mrs. X had known wet macular degeneration in the left eye, received treatment, but it didn’t work. From a practical standpoint, the right eye still worked well, allowing her to play golf and read. No harm, no foul. She must have developed the wet form in the right eye which caused the loss of the ability to read and play golf.
I performed a fluorescein angiogram, but there were no obvious signs of neovascularization (abnormal blood vessels that leak), but there was tremendous swelling. I still recommended Lucentis® intraocular injections. I cautioned that this was not the ideal scenario for this treatment, but I had nothing else to offer.,
My usual recommendations are to try a series of 3 intraocular injections, spaced 6 weeks apart, and then reassess. The morning of the first injection, Mrs. X was quite scared and anxious. The injection was delivered without any complications and done so……….comfortably. The subsequent injections were also uneventful.
After the 3rd shot, Mrs. X began to see better! We continued injections for the first year and half. After the 3rd Lucentis® injection, we switched to Avastin®. Treatment was even suspended for about 2 months due to a long planned vacation. Treatment continued until all the fluid in the retina was gone.
After about 6-8 months, Mrs. X started to be able to read certain portions of the newspaper. The reading ability continued to improve and stopped at 20/40. She is playing golf, too. Her last injection was over a year ago. She comes back to see me every 6 months.
What does this mean? Well, it is a success story. When we first started using anti-VEGF therapy, we only used it when there were obvious signs of neovascularization. This is determined by fluorescein angiography. Now, as was true in this case, we use anti-VEGF therapy for most cases of macular edema (fluid) with or without neovascularization.
Just as the disease took months or years to stop her from reading and playing golf, it took months for her to regain these functions. She was very patient, but did have the incentive of noticing improvement early on in the course of treatment.
By the way – I’d love to hear from you. If you have questions or comments about this case, please feel free to ask below.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist