Avastin use for myopic macular degeneration

I'm a 45 year old female, highly myopic (-8.5), with a history of retinal detachment in the left eye.  Surgery was successful and my vision was still correctable to 20/20 with contacts.  This week, I began to experience distortions on the Amsler Grid.  My retina specialist saw leakage only after a fluroscene angiogram.  Given that the leak is so close to my central vision, he recommends Avastin injections, which I see from prior postings seems to be the thing to do nowadays.  Can you point me to any papers that discuss this use of Avastin?  What can be expected and for how long must one get the injections...Am I looking at a lifetime commitment if it seems to work?  Or do you taper off?  Or is this an unknown at this point and all depends....

Second question...Since I am near a renowned Lasik Surgery center, I had hoped to get in to be evaluated, knowing it is unlikely they would want to touch such a severe myope.  With this current development of the leak and the fact that I'm now taking Avastin, should I just forget any chance of Lasik?  I would have liked to correct my distance vision while still healthy overall.  I have nightmares about being a little old lady in a nursing home who has lost her glasses!!!  It is terrible to not be able to see!

[John C Hagan III, MD, FACS, FAAO]

Avastin has dramaticially improved the chances to stop the lost of vision from wet froms of macular degeneration (as has the much more expensive Lucentis).

Here is a reference on Avastin. Remember Avastin is used to treat other diseases including cancer so some of the reference will not relate to wet MD. Also the website from the company that makes will not have the info since it's an "off label" use.

http://www.medrounds.org/amd/2005/10/avastin.html

You will need to be watched closely all your life for reoccurences or new Wet MD. On the average I think the number of injections per occurence is about 3-4 over say the first 6 months.

I would not proceed with lasik evaluation until you are 6 months out with no reoccurence. I doubt any lasik surgeon would do lasik on a patient with wet MD and under Avastin injections.

JCH III MD

[chrislav]

Thank you.  Sure hope it works.  It was very helpful to read your other postings to severe myopes.  It helps keep things in perspective.  Naturally, we all fear complete blindness.  Hopefully, for many of us it never gets that far.  Thanks again.

[John C Hagan III, MD, FACS, FAAO]

Just to reassure you. All forms of macular degeneration only affect the central 5% of the eye. Granted it is the most important for drive, read, etc but it DOES not affect the 95% of the retina for peripheral vision. So it will not make a person totally blind. Just FYI  a glaucoma patient that has lost all his peripheral vision but has central 20/20 vision is much more incapacitated than a macular degeneration patient that has lost all of his central vision but has all of his peripheral vision.

JCH III MD

[Paths]

I had Avastin injection for myopic macular degeneration five days ago. My vision suddenly changed one month ago, with distortion and could not read. I have done much research on this but cannot find out if this will one day travel to my other eye also, which has always been considered the worse. I had bleeding in the eye at injection site with eye weeping and closing after injection, the bleed seems to have traveled to the far right side of eye now and under lid. Is this normal? My vision is no better and I believe it is n fact worse. Please forgive my writing as it is a huge struggle to write or read. My RS says I will only need 4 to 5 injections, I am feeling I do not want anymore at all, unless my vision improves within the next month. I am very scared as my life is about writing. Any advicefrom anyone would be helpful. my e-mail is ***@****
Thanks you
Mary

[chrislav]

Dr. Hagan...Three months after only one Avastin injection, there is absence of any significant late retinal vascular or choroidal leakage.  Good news on that front so far.  In my case it did seem to help.

May I ask, given my situation described above, can you give me your thoughts on the significance of peripapillary RPE atrophy and mild macula pigmentary mottling?  I've tried googling on those terms, but get lost in the mire of scientific jargon.  Thanks.

[John C Hagan III, MD, FACS, FAAO]

I have both myself and just was in to see my retina specialist last week and he said not be a bit concerned. As long as neither progresses its not a big deal.

JCH III MD

[chrislav]

Thank you for your response.  My retina specialist didn't bring it up as a concern, but I thought maybe something else was developing that he didn't want to concern me about just yet!

Dr. Hagan, like a lot of others, I've spent time searching this forum's archives.  What jumps out at me in reading the threads of your responses is what a great manner you have must have with your patients.  You are able to explain things in a clear, concise, compassionate way, yet help keep things in perspective.  That is a gift.  Please know that there are people out here who appreciate your time and effort to answer these questions.  Best regards.

[John C Hagan III, MD, FACS, FAAO]

Most sincere thanks. And I dearly appreciate the successful efforts of my high school typing teacher that taught me to be an expert typist. Otherwise this would be far too time consuming for me to take on.

JCH III MD