maintenance Avastin for myopic md

I have myopic md, dx several months ago.  Had 3 shots that cleared up bleed and no abnormal blood vessels.  RS wants to do maintenance injections but I understand that this type of md is not necessarily chronic -- the bleeding, that is -- I have heard many people have a "bleed" that clears up and then not have another for some time, in some cases, years.  I did do one maintenance shot but am thinking that perhaps it is better to take a "wait and see" with frequent exams to see if there are abnormal blood vessels forming.  Is there any information that would help me to make this decision as I seem unable to find any answers on this issue.

[Michael J Kutryb, MD]

I am not a retina specialist, but I have not seen many "maintenance" injections being performed for patients these days. With the ability of macular imaging techniques and close patient follow up, it seems the treat and watch approach is much, much more common.  Of course every case is different and perhaps you just have a very bad case. You should consider getting a second opinion.  So far, I haven't been able to find a study to support maintenance injections as of yet.  Ask your retinal specialist to show you one.  I will keep looking.

Michael Kutryb, MD

[dukey]

You are spot on! Your MD is treating you like an ARMD patient which you are not. There is no need for maintenance injections for myopic CNV according to pretty much every study that I have seen.

[spookyluv]

Dukey, I have been watching your postings for a few months now, since this happened last January.  Although I have pretty good intuitive feelings about things, I am also just beginning to learn about this condition.  Can you direct me to studies on this?  Also, I have been watching your posts about posterior pole buckling.  At present I do not know my axial length, no one has said anything about staphylomas, my eye dr. (not RS) office personnel don't seem like they have even heard of the word.  I am a bit confused as to whether there there is a difference between "pathological myopia," "degenerative myopia," and "myopic degeneration.

I am wanting to turn every stone to maximize my vision, of course, like you or anybody I'd do anything to stave off damage.  Waiting impatiently for anything you might post that will enlighten those of us with this new diagnosis, how will we know when and where it is to be posted?

[dukey]

The first thing you should do is find a doctor who is at least familiar with pathological myopia. This is a tough task but you should try. Big teaching University clinics are often your best bet. The fact that you have had CNV is indicative of pathological myopia but at this stage it does not mean that you will develop all of the complications associated with it. Many simply have one or two bleeds which are treated with Avastin and that is it. A few years ago, things were very different. The bleeds could not reallly be treated and would essentially blind the patient due to scar tissue that would expand slowly over the years. It seems this is largely behind us now thank-god and many people will keep their vision because of it. It is true that there are other problems apart from CNV that can cause problems for the high myope but I wont go into all those here. From your posts, it is not clear if something drastic like posterior pole surgery is needed right now. It is still an experimental approach and is only really indicated for the worse cases.

Get a full work-up, axial length, B-scans, fundus photography etc with a good doc and then go from there.

[spookyluv]

Thanks for your info.  I have an appointment with Dr. Ward in Santa Cruz in August, since our airfare, hotel and car is free (frequent flyer stuff) I figured it was a no-brainer to be checked out by the best.  I just feel a bit in the dark as no one has even measured my axial length or done anything except treat the one bleed.  

[pingoman4]

HI dukey,
I was diagnosed recently with Keratoconus, and underwent a keraring insertion, and i'll undergo more surgeries (cros-linking).
My mom was diagnosed with Myopic degeneration and we are searching for the best retina specialist in town (I live in Lebanon).
I'm a med student, so i know about these stuff.
I just wanna askyou from where are you getting your information? Are you readin scientific articles?
Because i saw that you know a lot about this condition.
Can you give me your email address?