Retina Treatment FAQs
Who Needs Retina Injections?
Retinal conditions are the leading cause of permanent blindness in our country. Diabetic retinopathy is the leading cause of blindness in the working age population, and wet macular degeneration is the leading cause of blindness in the elderly. Both of these conditions - and several others - can be treated with the injection of medication into the eye. The medication helps reverse the bleeding and swelling of the retina, in order to improve and preserve vision.
Are Retinal Treatments Covered by Insurance?
Yes! You may be responsible for deductibles or copayments, but ALL medical insurances cover the cost of these treatments.
Are These Treatments Painful?
Fortunately, the vast majority of patients report that they are NOT painful. Dr Grange utilizes modern antiseptic and anesthetic techniques to make sure they are as safe and painless as possible. The vast majority of patients require topical anesthesia only with proparacaine (anesthetic) drops in the eye. A few patients prefer a sub-conjunctival injection of lidocaine anesthetic ("an injection before an injection" - this may lead to more bruising from the injection, but provides a stronger nerve blockade). Dr Grange will gladly work with you to find the numbing approach which works best for you.
Typical Treatment Regimen?
Once your eye doctor has determined that you are a candidate for these treatments, the standard recommendation is a series of three injections every month for three months. Please note: the first injection may or may not have a big impact on vision, but typically three injections do. Also one solitary injection is rarely if ever curative. These are typically conditions which we manage, as opposed to ones we cure. During the course of treatment, your vision gets measured, along with intraocular pressure, and a scan is done of the back of the eye. Typically after a series of three injections, Dr Grange will sit down with you to thoroughly discuss whether or not the treatment is working and what future treatments may look like. In the majority of cases, the treatment succeeds and the goal moving forward would be to extend the treatment interval between injections (e.g. go from every 4 weeks to ever 6 weeks, then every 8 weeks, etc). Unfortunately, there are some patients who manifest no significant improvement, at which point other treatments may be attempted or you may be referred to a retina specialist in town.
What To Expect Afterwards, and Standard Post-Treatment Recommendations?
It is very common to have a small bubble from the syringe enter your eye after treatment. This will look like a black sphere which paradoxically settles at the bottom of your vision ("an optical illusion"). These bubbles typically dissipate and get absorbed quickly - usually within the first twenty-four hours.
The most common cause of pain or irritation after the injection is from the betadine disinfectant used to clean the eye (the brown solution dropped into the eye right before the injection). This can feel like shampoo or soap in the eye. Dr Grange typically will give you a sample of artificial tear drops (common over-the-counter brands include: Refresh, Systane, Blink). It is typically recommended that you put a bottle of artificial tears in the refrigerator and use them liberally after your injection. Nice cool drops of artificial tears helps soothe the eye and help rinse out the betadine disinfectant solution from the eye. Feel free to use several drops of artificial tears upon returning to your home after the treatment. If you still feel any amount of discomfort around the eye, take oral tylenol or ibuprofen and consider holding a cool compress over the eye. If you are experiencing a significant amount of discomfort please contact our office.
It is very common to have a small amount of bleeding on the white of the eye after the injection. For most patients, this looks like a small red spot at the site of injection. Elderly patients, and patients on blood thinners occasionally have more significant bleeding after the injection. This bleeding usually does not interfere with vision and typically clears on its own. If you have any concerns about post-injection bleeding, please don't hesitate to contact our office.
What Are The Risks of Retina Treatments?
The biggest and scariest risk after retina injections are infections in the eye. Fortunately, using modern techniques, Dr Grange enjoys a good track record of fewer infections than the national average. It is imperative after your injection that you avoid rubbing the eye. The typical manifestation of an infection in the eye would be pain, redness and blurry vision presenting days after your injection, which gets worse and worse. Please see the above topic in which it is discussed that some redness, pain and visual distortion is to be expected immediately after the injection, but if these problems appear days afterwards and seem to be getting worse and not better, please notify our office right away. If an infection is caught early, the treatment usually involves antibiotic drops and injections in and around the eye, and the prognosis is usually good.
Another well-known risk of injections which can be sight-threatening is a retinal tear or retinal detachment. This can manifest as flashes, floaters, or curtains/shadows/veils which appear after the treatment. If you have any concerns about this following your treatment please call and come in right away. We will dilate your eye and take a thorough look to make sure that there is no retinal tear or detachment. When these are caught early, the treatment is usually benign and the prognosis is good. Unfortunately, when these tears or detachments are caught later, the prognosis declines.
What Specific Medication is Used?
The first drug used by Dr Grange - as well as most eye doctors around the country - for treatment of macular edema will likely be Avastin (Bevacizumab 2.5mg/0.1ml). Avastin is a monoclonal antibody that functions as an angiogenesis inhibitor. It had been used for decades as a chemotherapy agent before it was found to be effective and safe for treating a myriad of blinding retinal conditions. There is a whole host of publications supporting its utility and efficacy, and has been safely used for decades by Dr Grange and other eye surgeons. Of the myriad retinal treatments available nowadays, Avastin is the cheapest to the patient and their insurance company and the most readily available and this is why it is frequently used as first-line treatment.