What is OCT and why is it necessary?

OCT stands for "Ocular Coherence Tomography". It is a brilliant new technology which allows for a very precise, non-invasive evaluation of the macula (central retina). Exquisite details of retinal structures can not only be seen...but measured very precisely...and monitored for change (improvement or worsening) over time.

The most common use of OCT is for the evaluation of macular degeneration. Very subtle collections of fluid or blood can be detected...the OCT is key to the determination of whether additional treatment is or is not required.

Many other problems...such as macular holes, vitreomacular traction, epiretinal membranes and macular edema...are also best evaluated with OCT.

In Ontario...OCT is now covered by OHIP.

How soon after retinal surgery can I swim?

In general...it is recommended that one doesn't swim for at least a month after retinal surgery. The main concern is the risk of infection from the water. What would otherwise be a trivial case of "pink eye" can become a serious infection if a surgical wound has not completely healed.

Is general anaesthesia required for retinal surgery?

Most people do not require general anaesthesia.  The eye can be very well frozen with an injection behind the eye.  In addition...the anaesthesia team gives patients intravenous sedation...so patients typically drift in and out of being awake.  If however a patient insists that they do not want to be aware of anything during the surgery...general anaesthesia can be used.

Are there any new drugs on the horizon for wet macular degeneration?

The short answer is NO.

The results with Lucentis have been so great...that many other manufacturers have abandoned development of drugs that they had been exploring...due to the huge costs involved. Any new drug will have to be shown to be better than Lucentis.

Currently...a drug called VEGF-Trap is in Phase 3 FDA trials...results are expected perhaps in 2011. VEGF-Trap will have to be shown to have better visual acuity improvement and/or less frequent dosing to have potential.

Very sophisticated new laser systems are also being explored (Opttx Medical)...perhaps to be used together with Lucentis...to decrease the number of injections required.

How many Lucentis injections will I need?

It is impossible to predict the number of injections a person will need for "wet" macular degeneration. It is important to recognize that Lucentis is not a "cure" but rather a maintenance therapy for macular degeneration. The body stimulates the growth of abnormal blood vessels in wet ARMD...for reasons that are not entirely understood. The body produces a chemical called VEGF...which stimulates the growth and leakage of these abnormal blood vessels. Lucentis...specifcally blocks VEGF...however Lucentis stays inside the eye only for about four weeks...and is then absorbed by the body...therefore...almost always...when the Lucentis gets absorbed...the blood vessels start to grow and to leak again...and more Lucentis is then required.

Most retinal specialists treat patients in a schedule similar to the following...an initial course of three Lucentis injections every four weeks...then careful monthly follow-up...with repeat injection at the earliest sign of recurrence or persistence of blood vessel growth and leakage.

What are the risks of an injection into the eye?

Retinal specialists inject an ever increasing number of medicines into patient's eyes (Amphoterecin, Kenalog, Macugen, Avastin, Lucentis, etc). These various medications have been extremely helpful in the management of many diseases such as macular degeneration, diabetes, infections and retinal vein occlusions. Techniques and anaesthetic agents have improved dramatically over the years...making the procedure much less uncomfortable than most patients fear.

There however still do exist some risks...from the injection itself. The main risks are that of infection ("endophthalmitis"), bleeding into the vitreous cavity, retinal tears, retinal detachment, cataract or corneal abrasion. The vast majority of patients however experience only minimal discomfort at the time of the procedure...and mild swelling and redness for a day or two post-injection.

What is VEGF-trap

VEGF-trap is a drug currently being investigated for the treatment of "wet" macular degeneration. As with Lucentis...it needs to be injected into the vitreous cavity...at a frequency yet to be determined...but in the four to six week range...also much like Lucentis. Much future study is still required to determine the efficacy and safety of this drug. Approval...if it is to occur at all...will not be for several years.