Myopic degeneration/lacquer crack

[wwhmustaine]

I was recently diagnosed with myopic degeneration in my right eye, and told that I have a lacquer crack in that eye. I am 40 years old, and as a practicing attorney, am obviously concerned that my condition will either worsen in my right eye, or also develop in my left eye, thus rendering me essentially disabled.  Is there any treatment, therapy or surgery available for my condition? If not, what are the best preventative measures to take to ensure the condition does not progress in my right eye or begin develop in my left eye?  Lastly, what is the likelihood that the condition in my right eye will worsen, or that it will also develop in my left eye?  In other words, is it likely that I won't notice any significant decline in my condition over the next few decades?

[dukey]

Congrats, the success of Avastin in PM is much much higher than ARMD and usually only requires one injection. If you catch it early, you should reduce the chances of post-CNV scarring which is the real source of vision loss from CNV. There is some controversy as to whether Avastin can prevent this scarring but other factors such as original CNV size and location as well as the patients age are more important. Overall I think it looks good for you.

My feeling is that Lacquer cracks are no where near as dangerous now that Avastin is around, unless it passes right through your fovea and mechanically disrupts the vision. A few years ago with a subfoveal CNV, you would probably be down to 20/100 already and legal blindness in that eye would have been inevitable at some point.

I still think you have a staphyloma though. It is VERY rare to have myopic degeneration and not have one. Yours may not be too deep.  

[wwhmustaine]

Quick update:

I went back to my local RS Monday the 6th (4 days post-injection), and my right eye had improved to 20/35.  Then yesterday the 7th (5 days post-injection) I went to Emory Univ. in Atlanta, and it was down to 20/25+.  So in 5 days, it went from 20/50 down to 20/25+, and hopefully will improve even more. In a nutshell, the Avastin worked.  (Amazing that when the local guy gave it to me, he said that only 40% of patients who receive the injection notice any improvement. That may be the case for AMD, but obviously not for PM, in which at least one study has shown a mean improvement of three lines.)

The RS I saw yesterday at the Emory Eye Center, which is a top 10 facility, was by far the most knowledgeable I've seen to date, and he echoed the opinion of all 4 local specialists I've seen who said that there is no staphyloma. It'll be interesting to see what Dr. Ward says on Aug. 6 when I see him.

Also, thankfully, the Emory RS said that the left eye looks "great," that there's no crack there, no sign of one, etc.

[dukey]

Yeh this is a massive thread now! Glad it was of use.

[virginiana]

This thread (and not just this one) has been really informative. Thank you all!
I am 33 ansd also a lawyer, so it was quite a disaster when I found out 1,5 months ago that I have CNV in my right eye). I had my first Avastin shot in the beginning of June and it took a week to notice the difference, after one more week everything was almost perfect (and it is "almost perfect" today also - only if I search for it I am able to detect some waviness).  Nevertheless, my RS says that she believes in aggressive treatment, so I got my second shot last week and there is one more coming. I hope for the best (don't we all :)), although last week I had a bad surprise - quite accidentally they discovered another crack in my "better eye" too. Noone knows whether they just didn't see it before or it is just something very new. Anyway, I'd better start waiting for CNV there also.
Best luck to you!

[dukey]

Try not to worry, you are looking at weeks rather than days. The improvement has been shown to be exponential up to 12 weeks with the earliest detectable improvements being seen only at 2 weeks. The short term effects were part of the early studies on Avastin and myopic CNV. You are only at 2 days so you have a way to go. It may also take more than one injection but this is rare in myopic CNV.  

[wwhmustaine]

Anybody have any idea how long it takes for the Avastin to take effect? It's been 2 days since the injection, and there's been no change.

The following 2 articles seem to bode well for me, but they don't say how long it takes to work.

http://www.lowvision.com/avastin-benefits-patients-cnv-myopic-egeneration/

http://www.myvisiontest.com/newsarchive.php?id=779