Drug Therapy

VEGF Inhibitor

Intraocular injections are commonly used to treat retinal diseases such as diabetic retinopathy, macular degeneration and retinal vein occlusion.  These conditions cause damage to the retinal blood vessels, cutting off the supply of adequate amounts of oxygen to the retinal tissue.  In response to this, abnormal production of a blood vessel hormone called vascular endothelial growth factor (VEGF) takes place.  VEGF causes fragile, abnormal blood vessels to grow inside the eye. These abnormal blood vessels will rupture and bleed, often causing severe vision loss.

FDA-approved medications are injected directly into the eye to help patients maintain their baseline vision and keep vision loss at a minimum. They act as VEGF inhibitors.  Many patients often see an improvement in their vision from these injections as well. Intraocular injections are especially effective in treating wet age-related macular degeneration, which, although less common than the dry form, accounts for more than 90% of blindness caused by the disease.

This procedure is performed in your doctor’s office. Before the medication is injected, the eye is numbed with anesthetic eye drops to help minimize discomfort. The eye is then cleaned with an antiseptic solution and held open with a speculum. The medication is injected directly into the eye.

Patients may experience some mild discomfort or scratchy sensations after the injection. Although rare, side effects may include eye pain, conjunctival hemorrhage, floaters, increased eye pressure and inflammation of the eye. Patients can minimize the risk of these side effects by choosing a skilled and experienced doctor to treat all of their eye conditions.
Some of the medications used most successfully as VEGF inhibitors include:

• Eylea has been approved by the FDA for the treatment of wet AMD.  These injections are provided every four to eight weeks.  Eylea has been proven effective in helping those with AMD maintain, or sometimes even improve, their visual acuity.

• Lucentis is a prescription medication for the treatment of patients with wet AMD.  It received FDA approval in 2006 after studies showed its ability to help maintain or improve vision in these patients.  Lucentis is typically given in monthly injections.

• Avastin is a medication that can reduce swelling in the macula, prevent further vision loss and even improve vision for some patients. Avastin was originally developed to treat colorectal cancer and is FDA-approved for that purpose. However, studies have shown that Avastin can also effectively treat retinal diseases. Avastin is given in a series of injections about four to six weeks apart.

• Macugen was the first VEGF inhibitor to be approved by the FDA for the treatment of wet AMD in 2004.  It has been proven effective at slowing AMD-related vision loss.  Injections with Macugen are provided every six weeks for most patients.

Corticosteroid

Corticosteroids are a type of medication used to reduce inflammation and treat conditions such as macular edema.  Corticosteroid treatments are administered by injection, providing quick results and only a mild amount of discomfort.  We offer several different types of corticosteroid to provide relief to our patients.

• Iluvien (fluocinolone acetonide) is a tiny implant injected into the eye (vitreous) and used for the treatment of diabetic macular edema.  It is designed to release a continuous, low dose of corticosteroid to the retina for 36 months.

• Ozurdex (dexamethasone) is a biodegradable implant injected into the eye (vitreous).  Ozurdex is often used in the treatment of diabetic macular edema, macular edema following retinal vein occlusion and noninfectious posterior segment uveitis.

• Triesence (triamcinolone acetonide) is a variation of triamcinolone suspension that is made without the use of preservatives.  It is often effective in the treatment of sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids

Photodynamic Therapy

Photodynamic therapy is used to treat a complication of wet macular degeneration in which leaks form beneath the retina. These leaks occur in a structure in the eye called the choroidal neovascular membrane, or CNVM.

• Visudyne During photodynamic therapy, Visudyne (verteporfin) dye is administered through an infusion. Once delivered, a narrow-wavelength laser beam is focused on it for about 90 seconds. The dye absorbs the energy and slows or stops leakage by creating blood clots and stopping abnormal blood vessels from growing. Following treatment, patients should avoid direct exposure to sunlight for several days. Patients most likely to benefit from treatment will have newly onset macular degeneration and no scarring. Vision stabilization is maximized with a series of treatments over one to two years.