When To Stop Your Eye Treatment

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When To Stop Your Eye Treatment

Patients should stop treatment for wet macular degeneration if the treatment isn't working or the vision has not improved as expected. Doctors should support this decision.

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.”

Recommended Treatment for Wet Macular Degeneration

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 Better Vision

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

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?

Practical Concerns

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 Support Patient’s Decision

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. 

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Comments
  • Don Marcell February 6, 2014 at 12:44 pm

    I have WMD in my right eye. I have been treated w/one kenelog (steroid) shot in the back of the eye ball followed by four Avastin shots which provided positive effects per testing equipment however I cannot say I had improved vision. Two months later tests showed I was back to where I started. A fifth injection of Avastin to the eye was given which a month later showed to be ineffective Six weeks later after giving much thought of what life would be with out sight I returned to my retina specialist and jointly made the decision to try more shots. I was given another steroid then and scheduled for the start of Avastin in two weeks. As for now my thoughts are to go for a year and then reevaluate my situation.
    My Etymologist suggested I-Caps MV one a day which I have increased to the recommended two a day.I am open to evaluate other medication.
    While poking around on the some how Lucentis obtained my name and e-mail and started a mailing program. I sent the parent an e-mail inquiring how did they come upon my info and the e-mail was returned? Odd.

  • Don Marcell February 6, 2014 at 12:50 pm

    I have WMD in my right eye. I have been treated w/one kenelog (steroid) shot in the back of the eye ball followed by four Avastin shots which provided positive effects per testing equipment however I cannot say I had improved vision. Two months later tests showed I was back to where I started. A fifth injection of Avastin to the eye was given which a month later showed to be ineffective Six weeks later after giving much thought of what life would be with out sight I returned to my retina specialist and jointly made the decision to try more shots. I was given another steroid then and scheduled for the start of Avastin in two weeks. As for now my thoughts are to go for a year and then reevaluate my situation.
    My Etymologist suggested I-Caps MV one a day which I have increased to the recommended two a day.I am open to evaluate other medication.
    While poking around on the internet some how Lucentis obtained my name and e-mail and started a mailing program. I sent the parent an e-mail inquiring how did they come upon my info and the e-mail was returned? Odd.

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