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…………
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.
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.”