The decision to stop your eye treatment for wet macular degeneration should be easy…and guilt free. The anti-VEGF injections (treatment for wet macular degeneration) require multiple injections and many trips to the office. Injections are often recommended for over a year. It can be a real hassle and becomes a hardship for the friends and family… and sometimes the goals of the therapy seem “blurry.”
Whether the treatment entails Avastin, Lucentis or Macugen, the present recommendations are about the same. All are recommended to be given as a series of injections, every 4-6 weeks for at least a year.
Instead, I usually recommend that a patient, and their family, consider making a commitment to an initial set of 3 injections and then consider additional treatment. At my practice, this means 3 trips to the office spaced 6 weeks apart over 12 weeks.
After the 3rd injection, I recommend re-evaluation 6 weeks later. Two things can happen; the patient has improved or the patient has not improved.
Patients who have improved are now highly motivated to continue the injections. The success speaks for itself, the patient is aware of the benefits (i.e. improved vision) and we continue with the intraocular injections. If the leakage has stopped, we monitor for recurrence.
In general, the better the vision, the more vigilant we are about monitoring and the more aggressive we are about the injections.
It is an easy decision to continue treatment.
Patients who don’t get better vision may have some tough decisions to make. Should treatment continue?
Often, the patients that have not improved after the initial injections consider dropping the injections. After 3 injections the vision should have improved and/or I can tell if the treatment is working. Why continue treatments if it isn’t working after 3 injections?
I am likely to agree with stopping especially if the vision is much worse than the other, non-treated, eye. In these situations where one eye is always going to be worse, regardless of additional treatment, is there value to more shots?
Regardless of the age of my patient, I like to have someone else drive them to the office on “injection day.” I don’t want my patients driving after receiving an injection into their eye. It may be too distracting while they drive.
Often this means a family member must take time off from work. Doctors are not always mindful of the burden these treatments may put on a family.
Doctors should clearly state that continued treatment is unlikely to improve the vision. This should relieve the guilt of not continuing treatment. A doctor’s job is to educate well enough so that a patient is able to make qualified, and informed, decision.
What Does This Mean? Treatments for wet macular degeneration are great. The anti-VEGF medications work really well, but there is a down side.
The treatments requires many office visits and can last more than a year and requires a lot of support/help from family and friends. They also don’t work in every case.
So many patients feel obligated to their doctor to continue their treatment. The solution would be easier to the make, if , many times, the doctor would remove the guilt.