I am excited to be attending the American Society of Retinal Specialists convention next week. Five years out of the clinical setting makes it essential I attend conventions to try and freshen up on the new and exciting progress in the retinal world. It doesn't hurt that the convention is being held on the island of Maui! This is my first tip back to Hawaii since holding my very first position in an ophthalmology practice. I was an ophthalmic assistant at the Hawaiian Eye Center under the direction of John M. Corboy, MD. He was a pioneer in cataract surgery and used the phacoemusification technique and refractive nuances to achieve an extraordinary percentage of naked visions under 20/40. And that was in 1989! Not to mention he was quite the business man. He encouraged me to get certified as an assistant, I was a youngster of 23 at the time. Later I certified as a technician and learned the skill of fluorescein angiography.
As I mentioned after a convention in New Orleans earlier in the year, there doesn't seem to be a great amount of change happening in the surgery for macular holes, but whatever is happening I aim to keep up with. A recent customer was involved in a study in California using some new techniques I hope to learn more about.
One of the few surgeons most adamant about the lack of a need to position face down after macular hole surgery will be there, Paul Tornambe, MD. When I met Dr. Tornambe at the ASRS convention in New York in 2003 he told me I would probably be in business for about five more years before face down positioning would be obsolete. Certainly the standard two weeks of positioning has fallen to more like 7- 10 days, but by far, most retinal surgeons continue to require patient compliance with the face down recovery process. Some retinal surgeons, even while requiring their patients to position, feel the positioning equipment my business revolves around is unnecessary or too costly. It is true some patients get through the recovery successfully without assistance, but no one is going to say it is easy. I cannot please everyone every time, but I continue to stay in business because many people are served well by Kelly Comfort and by me.
Undoubtedly, I will have much to learn next week about the progress being made in the treatment of macular degeneration. Really exciting things are happening there. When I left clinical work in 2003 I was actively involved with the latest treatment for exudative macular degeration at the time, Photodynamic Therapy or PDT. The practice I worked for in Pittsburgh, PA was involved in the clinical trials before it became FDA approved. It was an exciting time, but wow, the stuff they are doing now...I'll be taking lots of notes.
I look forward to sharing whatever I learn with you!
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Sunday lectures were dedicated to Macular Degeneration. Photodynamic Therapy, PDT, the latest and greatest treatment for age related macular degeneration (AMD)5 years ago when I was working in the clinic, has now become mostly an occasional adjunct to the new treatment of choice: anti VEGF intravitreal injections. Two drugs have risen to the top as proven therapy for exudative, or wet, macular degeneration: Avastin (bevacizumab) and Lucentis (ranibizumab). There seems to be debate as to the interchangability of the two drugs and apparantly there is some concern over their possible affects on the other systems of your body. Benefits appear to far outweigh the possible complications and the treatment is now done in every retina office. Like PDT, repeated treatments are needed to curtail the disease; the need for multiple visits to the retinal specialists office was discussed from the physicians and the patients perspective, mostly the physicians. The persistant problem of long waits in your retina specialists office isn't going away as long as the abilty to see and treat same day is available. So take along your reading material or your soduku and be prepared to people watch for a while. No need to get yourself upset, just plan on making a day of it, and hopefully you will continue to be able to enjoy central vision for a while. I want to mention two specific presentations I think are of particular interest to the lay population at large. One, given by the very well known and respected retinologist Bert Glaser, MD, discussed taking samples of the vitreous before intavitreal injection or vitrectomy and analyzing them for specific proteins as a guide for treatment. This method tailored treatment specifically for each patient similar, I think, to the recent advances made in cancer treatments. Exciting stuff. The other presentation was by Susan Bressler, MD, who has taken over the top spot on my most admired list. Her presentation discussed a study on the relationship of cataract surgery and the progression of macular degeneration. The study did not provide evidence that cataract surgery increases the risk of AMD progression. Good news.
ReplyDeleteMonday's topic is diabetic retinopathy.
More info on Avastin (bevacizumab) and Lucentis (ranibizumab) as I understand it: After extensive research and development (read expensive studies)the FDA approved Lucentis, created by the pharmeceutical company Genentech, for intravitreal use in the treatment of neovascular age related macular degeneration. A very similar but molecularly different drug, Avastin, has been used essentially interchangeably with Lucentis by retina specialists. Avastin was also developed by Genentech but only studied by them for intraveinous cancer treatment; both, however, are being covered by Medicare for the treatment of AMD. But guess what? These anti VEGF drugs appear to have significant effects on other ocular disease processes involving abnormal blood vessel growth. The use of these drugs for other diseases constitutes off label use. Translation: not covered by insurance. Now for the really interesting part. There is another significant difference between the two drugs; Lucentis, with all its R and D,costs many many times more than Avastin. Would you be surprised to learn Genentech is not supporting the ongoing studies of Avastin for intravitreal use?
ReplyDeleteHi Kelly,
ReplyDeleteMy name is Iscah and I live in Anchorage, Alaska. I was recently diagnosed with Macular Hole in my left eye and schedule for surgery on the 23rd of October. I ordered your rental and it was delivered on the 17th.
I am an office worker who sits in front of a computer for about 7 hrs of my 8 and a half hour day. After my 10 days recovery will I be able to return to work and give 100% to my employer? Or, should I stay out longer and return to work part time before going full force? Also, do you know of a vitrectomy/macular hole support group in Anchorage Alaska?
Thanks,
Hi Iscah:
ReplyDeleteHow you will be able to function at work is really going to depend on the function of your nonsurgical eye. Your affected eye will probably still have some difficulty seeing properly at 10 days, which will affect your depth perception and make it a little difficult to perform at 100%. You and your employer may want to discuss how much is expected of you if you return to work that soon. It will not harm either eye to be used, even 'strenuously', once you return to work, but please be sure to get the OK from your surgeon before you go back.
I am unaware of any support groups for macular hole anywhere! I am happy to try and answer any questions you may have and I want to encourage you to post more comments as you progress through your recovery!
Thanks for writing this.
ReplyDeleteHello,
ReplyDeleteI am in Italy and need an advice. If you had your child with a macular hole due to a thrauma, and have to go to the best specialists in US to have him operated, where would you bring him?
Thank you so much, it's crucial for us to know the right places-names.
Please, it's really urgent and serious... I have to do this travel of hope for my child, they suggested me to go to USA, but I don't know where to go and to which specialist...
ReplyDeletePlease help me!