Ophthalmologists can help reduce the burden of injection therapy
April 04, 2022
1 minute read
Biography: Luo is a retinal surgeon at Bay Area Retina Associates in Walnut Creek, California.
Disclosures: Luo reports that he is a consultant for AbbVie, Alimera, Allergan, Genentech, Iridex and Lumenis and receives research grants from Allergan and Lumenis.
Each patient has a treatment burden. Think about it for a moment.
As physicians, we often look at clinical trials, see an optimal treatment protocol, and intend to implement it. But our interactions with patients are usually specific to the disease we treat and completely isolated from the realities of their daily lives. For example, we often don’t consider how long it takes to get to our office or how long it takes to cancel work or find daycare for them to come to their appointment. And we may only have a minimal understanding of the other medical treatments they also undergo.
If we really want to successfully treat our patients holistically rather than just their disease, we need to reduce the burden of treatment whenever possible. For example, anti-VEGF injections work exceptionally well for retinal disease, and we are lucky to have them. But for optimal anatomical and functional results, continuous and repeated treatment is necessary, and it is not easy for patients to come in frequently to have a needle inserted into their eye.
The MicroPulse laser (Iridex) is an adjunct therapy that can significantly reduce injection burden. It can reduce the frequency of injections and allow patients to space out their visits, even those at risk of progression. In a retrospective study of patients with diabetic macular edema, 19 eyes were treated with ranibizumab alone, and 19 eyes were treated with both ranibizumab and the subthreshold MicroPulse laser. At 12 months, the improvement in visual acuity was similar in the two groups. However, the group that also received the MicroPulse laser treatment required an average of 1.7 ranibizumab injections compared to an average of 5.6 injections in the group that did not receive MicroPulse. At the end of follow-up, the difference had increased to an average of 2.6 injections in the MicroPulse group versus an average of 9.3 injections in the injection alone group. Additionally, with the growing number of publications evaluating retinal thickness variability as a biomarker of poor prognosis, MicroPulse may also reduce these fluctuations in patients who may have suboptimal follow-ups due to external factors.
I can’t say clearly enough what difference it makes for patients. The potential halving of required visits can have as much of a positive impact on their real life as improving their vision.
Moisseiev E, et al. Eur J Ophthalmol. 2018;doi:10.5301/ejo.5001000.