22 Jan "Mrs. Ozurdex" Does Not See Well
Ok, so Mr. Ozurdex is doing well. What about Mrs. Ozurdex?
“Mrs. Ozurdex” (the names have been changed to remain HIPAA compliant) came to my office in November with complaints of sudden, painless loss of vision in her left eye. I diagnosed her with a central retinal vein occlusion (CRVO). Again, this is a different diagnosis, and problem, than diabetic retinopathy or macular degeneration.
There is no standard treatment for central retinal vein occlusions. None. There is, as with Mrs. Ozurdex, a significant loss of vision caused by loss of blood flow to the retina. Traditionally, there is nothing that can be done to improve the vision. The prognosis is worse than a branch retinal vein occlusion (BRVO) which plagues Mr. Ozurdex (yesterday’s post).
The Ozurdex™ system is FDA approved for Retinal Vein Occlusions. There are two types: branch retinal vein occlusions and central retinal vein occlusions. The visual prognosis is much worse for the CRVO. Ozurdex will release a steroid, over the next 4-6 months, called dexamethasone. Dexamethasone is an old, old drug, but has been shown to be useful in treating the macular edema (swelling) present in vein occlusions. In theory, by reducing the macular swelling, the vision may improve.
Regardless, Ozurdex was injected into Mrs. Ozurdex’s eye about 2 weeks ago. I don’t think she will see as well as her counterpart. Why? The difference is in the two types of vein occlusions. The vision has always been worse for patients with CRVO compared to BRVO. They are almost two different diseases.
On the other hand, the Ozurdex studies showed some realistic improvement in the swelling caused by CRVO. We have no other treatment – and I was quite forward with Mrs. Ozurdex. As Ozurdex is reimbursed by Medicare, her insurance should cover the costs.
Mrs. Ozurdex’s right eye is normal and sees very well. Mrs. Ozurdex’s left eye sustained the central retinal vein occlusion and is legally blind (can NOT see the big “E”). While there is likely to be some improvement after treatment with the Ozurdex drug delivery system, there is probably going to remain a large difference between the two eyes. Do we want to try anyway? What do we have to lose?
She’ll be returning to the office in the next 1-2 weeks.
What Does This Mean? This is a common consideration in treating patients with retinal disease; especially patients with macular degeneration and diabetic retinopathy. Many times patients have significant loss of vision in one eye and normal vision in the other, or “fellow,” eye. From a practical approach, there might be improvement in the poor eye, but no, real functional improvement overall. In other words, the moderate improvement in the poor eye doesn’t really improve a patient’s overall visual function and abilities. Sometimes we forego treatment and sometimes we proceed.
Mrs. Ozurdex is a “glass is half full” person. Regardless of the outcome, she’ll be happy. If the sustained release steroid treatment works, she is rewarded with improved vision. If it does not work, she is satisfied that she tried everything possible to help herself.
Retinal treatments, for instance, treatment for wet macular degeneration, are not to be confused with cures. Treatments often improve or stablize vision, but rarely is there a “cure” with full restoration of vision and function.