visudyne therapy

Was diagnosed with wet AMD/PED 18 months ago; underwent Lucentis/and Avastin treatment with success; until last June when blood vessels started leaking again; had a shot of Avastin; another shot of Avastin weeks later; blister had gotten larger after first shot; had second shot in July and saw retinologist yesterday; eye is "stable' but he suggested being aggressive and starting Visudyne Therapy/ then stated my "retina" could be fried/as a downside; also stated vision loss; I choose another shot with the risk of rip/tear; my question is when I read articles I'm not able to see anywhere where there is a "danger" of burning the retina; I see where there is damage to surrounding healthy cells; my doctor had 31 patients to see that day; and unfortunately was stressed; so as a patient I didn't really have the "time" with him to discuss the pros and cons of Visudyne Therapy; from the literature it states begin now; my doctor said to be aggressive; then he switched to "he has to be conservative' I"m confused; I know you can't speak for him; but can you explain the cons of the treatment?

[Michael J Kutryb, MD]

Visudyne is a chemical that will travel in your bloodstream and into the blood vessels of the retina.  It wll also leak into the retina right in the area where the "wet" macular degeneration is leaking. This special drug basically is particularly activated by the special light that is directed into the eye - thus the name photodynamic therepy.  The upside is that since the chemical accumulates preferentially in the area of leakage - it allows the use of a lower power light source and there is less "collateral damage."  The downside is that, there is some damage possible not only to the healthy cells of the retina but also some potential damage to the area heavily affected by the macular degeneration.  Obviously photodynamic therepy has been overtaken by lucentis/avastin injections which are a hugely better treatment, however, there are some resisitant, troublesome, special cases where photodynamic therepy still has a place.  That's where the retina expert is needed, that is when is this treatment something to turn to.  I can't help you there and I'm very glad I have several excellent retinal specialists to turn to in my area.

MJK MD