TREATMENT WITH INJECTABLES AND REFERRAL FOR LOW VISION CARE

By Richard J. Shuldiner, OD, FAAO Chief Clinical Editor

There was a time when the only treatment for wet ARMD was laser surgery. At that time, eye care professionals knew that vision would be lost the moment that the laser beam hit the retina. At that time, it was recommended that low vision care be delayed until the final amount of vision loss was known.

Fortunately, those days are over. With the advent of the anti-VEG-F injectables, such as Avastin, Lucentis, Macugen, and Eylea, severe vision loss has become far less common. These injections help prevent neo-vascularization without damaging viable retinal cells. The first two injections help in the resorption of fluid leakage, which may restore some lost vision. On-going therapy is for the prevention of neo-vascularization, leakage, and further vision loss.

Many low vision patients arrive with a diagnosis of wet age-related macular degeneration and are undergoing treatment with injectables. One of the questions most asked is whether or not to continue with these injections. Obviously, the recommendations of the retina specialist should be followed to prevent further vision loss, so we always recommend continuing.

There are eye care professionals who recommend that low vision care be delayed until no further injections are required. This is a huge mistake. Treatment to prevent vision loss can go on for years.  Some patients have had ongoing injections for years with reduced vision that is stable. There is no logical reason to deny these people the help of low vision glasses and devices so they can resume the activities now lost. If low vision glasses and devices allow the patient to read, see faces, watch TV, work on the computer, or even drive safer, there is no reason to deny them the opportunity. Should further vision loss occur, later on, the low vision glasses or devices can be re-evaluated and upgraded as necessary.