Avastin Eye Injection Treatment for Macular Degeneration

Macular Degeneration eye doctor in Tampa Bay, Florida - Dana M. Deupree, M.D. Avastin Eye Treatment

Watch an Avastin Injection Animation

Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 years of age. It is caused by the breakdown of the central portion of the retina (the highly sensitive part of your eye that works like the film in a camera to pick up the picture) called the macula. The macula is responsible for the fine central vision in the eye that is needed for driving a car, reading fine print, recognizing faces, etc. There are two types of macular degeneration: dry and wet. In the wet form of AMD, abnormal blood vessels grow in the back of the eye. Sometimes these vessels leak blood or fluid that causes blurred or distorted vision. Without treatment, vision loss may be quick and severe.
Click here for an interactive Eye Anatomy Animation

There are other eye conditions that cause loss of vision due to abnormal

Avastin Flash Movie by JirehDesign.com

growth of blood vessels in the back of the eye. These can occur even in young patients, and include, but are not limited to, conditions such as high myopia (nearsightedness), histoplasmosis , angioid streaks, and eye injury. Sometimes there is no known reason for the abnormal blood vessels. Without treatment, vision loss may be quick and severe.
Macular edema, or swelling around the macula,, is edema that

affects vision but does not respond adequately to the usual treatment methods. It can occur with conditions such as central
retinal vein occlusion and diabetic retinopathy. Without effective

treatment, vision loss could progress and become permanent.

Off-Label Use of Avastin - Benefits

Avastin was not initially developed to treat your eye condition.

Based upon the results of clinical trials that demonstrated its safety and effectiveness, Avastin was approved by the Food and Drug Administration (FDA) for the treatment of metastatic colorectal
cancer . As a condition of approval, the manufacturer produced a

label explaining the indications, risks, and benefits. The label explains that Avastin works by blocking a substance known as vascular endothelial growth factor or VEGF. Blocking or inhibiting

VEGF helps prevent further growth of the blood vessels that the cancer needs to continue growing. Once a device or medication is approved by the FDA, physicians may use it off-label for other purposes if they are well-informed about the product, base its use on firm scientific method and sound medical evidence, and maintain records of its use and effects. Ophthalmologists are using Avastin off-label to treat AMD and similar conditions since research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions. Some patients treated with Avastin had less fluid and more normalappearing maculas, and their vision improved. Avastin is also used, therefore, to treat macular edema, or swelling of the macula.

Possible Avastin Limitations

The goal of treatment is to prevent further loss of vision. Although some patients have regained vision, the medication may not restore vision that has already been lost, and may not ultimately prevent
Illustration by JirehDesign.com Animate this image >>

further loss of vision caused by the disease. After the pupil is

dilated and the eye is numbed with anesthesia, the medication is

injected into the vitreous, or jelly-like substance in the back chamber of the eye. Avastin is administered by an injection into your eye as needed at regular intervals (about every four to six weeks); your ophthalmologist will tell you how often you will receive the injection, and for how long.

Avastin Alternatives
You do not have to receive treatment for your condition, although without treatment, these diseases can lead to further vision loss and blindness, sometimes very quickly. Other forms of treatment are available. At present, there are three FDA-approved treatments for neovascular age-related macular degeneration: photodynamic
therapy with a drug called Visudyne and injection into the eye of two

other VEGF inhibitors drugs called Macugen and Lucentis. Although both of these treatments have been proven to slow down the rate of visual loss, most people do not get back better vision.
Dr. Deupree will discuss with you the benefits and risks associated

with these other choices of treatment. In addition to the FDAapproved medications, some ophthalmologists use intravitreal
Kenalog a long-acting cortisone-like drugoff-label to treat eye
TM

conditions like yours.

Avastin Injection Complications

Complications when AvastinTM is given to patients with cancer When Avastin is given to patients with metastatic colorectal cancer, some patients experienced serious and sometimes life-threatening complications, such as gastrointestinal perforations or wound healing complications, hemorrhage, arterial thromboembolic events (such as stroke or heart attack), hypertension, proteinuria, and congestive heart failure.

Patients who experienced these complications not only had metastatic colon cancer, but were also given 400 times the dose you will be given, at more frequent intervals, and in a way (through an intravenous infusion) that spread the drug throughout their bodies. Risk when Avastin is given to treat patients with eye conditions

Watch an Avastin Injection Animation

Ophthalmologists believe that the risk of these complications for patients with eye conditions is low. Patients receiving Avastin for
TM

eye conditions are healthier than the cancer patients, and receive a significantly smaller dose, delivered only to the cavity of their eye. While there are no FDA-approved studies about the use of Avastin in the eye that prove it is safe and effective, there are ongoing clinical trials of a similar drug as well as studies of patients receiving Avastin off-label.
TM TM

One study of patients who received Avastin

through an intravenous infusion reported only a mild elevation in blood pressure. Another study of patients treated like you will be with intravitreal Avastin (that is, Avastin injected into the eye) did
TM

not have these elevations or the other serious problems seen in the patients with cancer. However, the benefits and risks of intravitreal Avastin for eye
TM

conditions are not yet fully known. In addition, whenever a medication is used in a large number of patients, a small number of coincidental life-threatening problems may occur that have no relationship to the treatment. For example, patients with diabetes are already at increased risk for heart attacks and strokes. If one of these patients being treated with Avastin suffers a heart attack or
TM

stroke, it may be caused by the diabetes and not the Avastin

TM

treatment. This possible relationship is the subject of ongoing

clinical investigations.

Known risks of intravitreal eye injections

Your condition may not get better or may become worse. Any or all of these complications may cause decreased vision and/or have a possibility of causing legal blindness. Additional procedures may be needed to treat these complications. During the follow up visits or
phone calls, you will be checked for possible side effects and the

results will be discussed with you. Any medication has the potential to cause allergic reactions in a small number of people. Symptoms of an allergic reaction can include a rash, hives, itching, shortness of breath, and rarely death. In general, allergic reactions to medicines are more likely to occur in people who have allergies to other drugs, foods, or things in the environment, such as dust or grass. If you have allergies to other medicines, foods, or other things in the environment, or if you have asthma, you should let Dr. Deupree or his staff know. Possible complications and side effects of the procedure and administration of Avastin include but are not limited to retinal
TM

detachment, cataract formation (clouding of the lens of the eye), glaucoma (increased pressure in the eye), hypotony (reduced

pressure in the eye), damage to the retina or cornea (structures of the eye), and bleeding. There is also the possibility of an eye infection (endophthalmitis). You may receive eye drops with instructions on when to use them to reduce the possibility of this occurring. Any of these rare complications may lead to severe, permanent loss of vision.

Patients receiving an injection of Avastin may experience less severe

TM

side effects related to the preinjection preparation procedure

(eyelid speculum, anesthetic drops, dilating drops, antibiotic drops, povidone-iodine drops and the injection of the anesthetic). These side effects may include eye pain, subconjunctival hemorrhage (bloodshot eye), vitreous floaters, irregularity or swelling of the
cornea, inflammation of the eye, and visual disturbances.
Some of this page's information provided by: Ophthalmic Mutual Insurance Company

Eye illustrations provided by www.JirehDesign.com.

Pain after Avastin Injection

We received the following question this week: "Has anyone other than myself suffered excruciating pain after an avastin shot?"

Typically patients feel very little or no pain with the injection. I inject anesthetic beneath the conjunctiva in addition to topical drops and then wait at least three minutes before giving the intravitreal injection. Some physicians use only topical anesthetic drops. Patients who receive only topical drops often feel a very brief sharp pain as the needle pierces the sclera and choroid. Excruciating pain is rare. Perhaps the needle pierced one of the nerves in the choroid which are more commonly found in the horizontal meridians (three and nine if you look at the eye as a clock) although there is a lot of variation. Or perhaps this patient was very sensitive to the increased intraocular pressure of the injection. Injecting anything in the eye will increase the pressure temporarily as if you are over-inflating a tire. The eye adjusts quickly though by draining fluid through the normal channels in the front of the eye and the pressure usually returns to normal. The volume of Avastin injected is 0.05 ml so the pressure rise is usually modest. Its unfortunate that this patient felt such pain but I doubt this means that anything went wrong. I also doubt that it was caused by the Avastin itself. Another cause of irritation of the outer surface of the eye can be due to the 5% Betadine that we use to sterilize the surface of the eye. I put a cotton tip applicator right on the conjunctiva

in the area where Im going to inject. I ask the nurse to irrigate the eye after I inject but some people still may get a mild chemical conjunctivitis. This typically lasts only a day or two and is treated with artificial tears and/or antibiotic eye drops. A more severe scratchy pain that can last two days can be due to a corneal abrasion. An abrasion means that the outer epithelium of the cornea is gone in a certain area. This exposes the underlying corneal nerves. This is due probably to the lid speculum rubbing the surface of the eye when it is put between the lids or removed. It may also be due to the speculum being in the eye too long. I take care not to rub the cornea with the speculum. I try to be ready to give the injection right after I put the speculum into the eye. I put the speculum in, touch the area gently with a Q-tip soaked in Betadine, measure the correct distance, give the injection, and then take the speculum out. The whole process should take about a minute. In patients who are prone to abrasions, I ask the nurse to put in a viscous liquid tear before I put in the speculum. This makes the surface of the cornea slippery which reduces the risk that the speculum will rub on it and cause an abrasion. Finally the pain ophthalmologists worry about is a severe dull pain that starts a day or a few days after the injection. This pain can mean an infection inside the eye. Not all intraocular infections (endophthalmitis) cause pain so we ask the patients to check their vision at least once a day for the first week after the injection. An intraocular infection will cause a lot of floaters and then a marked loss of vision. If you notice this, call your doctor right away. I thank this person for the question. I realize that he or she may not be too anxious to get another injection but remember that wet AMD typically causes severe central vision loss if left untreated so please dont give up. Talk to your doctor about the risk of pain after another Avastin injection or maybe another type of treatment.

Side Effects of Avastin - for the Consumer

Avastin Solution
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Avastin Solution: Changes in taste; constipation; diarrhea; dizziness; dry mouth; dry skin; hair loss; headache; increased thirst; indigestion; loss of appetite; minor nosebleeds; mouth pain or sores; muscle pain;

nausea; pain, swelling, or redness at the injection site; sluggishness; stuffy or runny nose; tiredness; voice changes; vomiting; weakness; weight loss. Seek medical attention right away if any of these SEVERE side effects occur when using Avastin Solution: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry stools; blood in the urine; calf pain or tenderness; chest pain; confusion; cough; coughing or choking while eating; coughing up or vomiting blood; dark urine; difficult or painful urination; fainting; fever, chills, or persistent sore throat; frequent or urgent urination; loss of coordination; numbness of the arms or legs; one-sided weakness; peeling of skin; seizure; severe or persistent headache; severe or persistent nosebleed; severe or persistent stomach pain, constipation, nausea, or vomiting; severe or persistent weakness; shortness of breath; skin discoloration, irritation, or lesions; speech changes; sudden, severe dizziness; swelling, discoloration, or pain in the legs; swelling of the hands, ankles, or feet; trouble swallowing; unusual bruising or bleeding; unusual or severe sweating; unusual weight gain; vaginal pain, bleeding, or discharge; vision loss, blurred vision, or other vision changes; wheezing; wounds that do not heal. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
Top