Timing Is Everything

Treatment saves vision from macular degeneration.

Norm Thurston enjoys retirement in Sun City Center after a long career with the telephone company in Michigan. Like many active retirees, he finds life is even busier than when he was working. He and his wife are shuffleboard enthusiasts, active in their church and volunteers with Feline Folks, a group that cares for their community’s feral cats.Norm Thurston treated for age-related macular degeneration by Anita R. Shane, MD, at Coastal Eye Institute.

He was already retired in his late 50s when he experienced a change that could have stopped his ability to drive, read or recognize people’s faces. It started when he noticed that people looked odd on his TV.

“Their faces started looking like caricatures. They were wavy and distorted,” he recalls.

Norm, who is now 70, saw an optometrist for a regular eye check-up a few weeks later. He mentioned how people on TV looked like cartoons. Right away, the optometrist referred him to specialists at Coastal Eye Institute.

An examination at Coastal Eye Institute revealed age-related macular degeneration, or AMD, an incurable eye condition. AMD affects the part of the retina that controls central vision and the ability to see details.

When central vision is gone, the ability to see straight ahead is obscured. People’s faces, or words on a written page, are covered by large blind spots.

Despite the seriousness of Norm’s diagnosis, he was fortunate. His macular degeneration was caught early, and a new class of medications was just beginning to revolutionize treatment.

Extending Shot Intervals

At Coastal Eye Institute, Norm received regular eye injections of a medication that slows the growth of abnormal blood vessels beneath the retina. The aim of therapy is to stop the fluid leakage and swelling that harms the retina.

The US Food and Drug Administration approved the first anti-VEGF medication for AMD, Lucentis®, in 2006. Anti-VEGF drugs target growth factors that allow fragile blood vessels in the eye to proliferate.

“These injections are to saving vision what the invention of penicillin was for treating infection. They have revolutionized treatment to be able to maintain sight for AMD patients and oftentimes improve it,” notes Anita R. Shane, MD, at Coastal Eye Institute.

Since the introduction of the medications, protocols have developed about how often to administer them.

Initially, monthly shots were part of a typical treatment plan, but some doctors now follow an as-needed schedule. That is, once AMD is stable, patients receive injections only upon signs of recurrence.

Dr. Shane – who is Norm’s ophthalmologist for his AMD – follows a middle ground between those strategies. She utilizes a treat-and-extend therapy based on timing set by the eye itself. For some patients, the protocol allows her to safely wean them from injections as their eyesight improves.

“Treat and extend starts out monthly. As we get rid of the blood and fluid beneath the retina, we stretch out the time between injections,” educates Dr. Shane. “If the eyes look good at five weeks, we extend the shots to six weeks, and we continue to stretch the time frame as long as the eyes look good.

“Let’s say that we get to nine weeks instead of eight weeks between shots, and an examination shows fluids in the retina have reappeared. The eye is telling us that it needs a shot every eight weeks to stay out of trouble,” she continues.

For patients who are able to stop injections, follow-up care is essential to ensure their macular degeneration remains stable. At each visit, Dr. Shane examines the eye to detect any blood or swelling. Retina scans are part of the examination to look for swelling at the microscopic level.

“When patients are weaned off the shots, initially I will see them fairly frequently to make sure they aren’t getting into trouble. I may see them a month after they normally would have had an injection and then stretch the next visit to six weeks thereafter,” explains Dr. Shane. “The purpose is to make sure we haven’t backtracked by stopping the injections.”

When Norm’s eyes were consistently stable between longer injection intervals,
Dr. Shane began to wean him from the shots.

He had regular follow-up visits to make sure the AMD hadn’t recurred. And Norm was diligent about using his Amsler grid, a paper grid that AMD patients use at home to spot signs of recurrence. The grid lines are straight, but AMD can make them appear wavy.

After about 18 months without injections, Norm noticed lines on the Amsler grid were distorted. He notified Dr. Shane, who examined him and started another injection regimen.

This time around, he is being treated with EYLEA®, an anti-VEGF medication approved for AMD in 2011. It works in the same way as other drugs for AMD in its class, but evidence suggests it may be needed less frequently.

“EYLEA is a medication that wasn’t available to us when Norm was first being treated for AMD,” notes Dr. Shane. “What’s nice about it is how it stretches out the time between shots.

Norm Thurston treated for age-related macular degeneration by Anita R. Shane, MD, at Coastal Eye Institute.

Norm’s eyesight is good, thanks to treatment for macular degeneration and
diligent follow-up.

“Norm is at the twelve- to thirteen-week interval between injections,” she adds. “He’s on his way to stretching out the shots further, and his eyes are doing great.”

Diligence Pays Off

After more than a decade of having AMD, Norm’s sight is good, thanks to excellent treatment and diligent follow-up.

He loves to read books on his Kindle® and in print and plays games every day on his iPad®. Once a week, he heads for groceries as a “food dude” with the Feline Folks to collect cat food donations.

Norm credits Dr. Shane for her superb care and expertise in treating AMD.

“Dr. Shane is a wonderful doctor, very smart and personable,” raves Norm. “She takes great care of you and is very concerned about everything.

“All of the people who work with her are the best,” he continues. “I see other patients when I’m there, and we’re all so grateful they can fix our vision.”

FHCN article by Susan Hemmingway. Photos by Fred Bellet. Stock photo from istockphoto.com. mkb
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    • Coastal Eye Institute

      Coastal Eye Institute is one of the area’s largest ophthalmology practices featuring a comprehensive team of fellowship-trained ophthalmologists in every subspecialty of eye care. They provide care for the total health of your eyes, from i... Read More

    • Anita Shane, MD

      Anita Shane, MD, is a Fellowship-trained retina specialist and Board Certified by the American Board of Ophthalmology. Dr. Shane received training from Baylor College of Medicine and Bascom Palmer Eye Institute, Miami. Her areas of exper... Read More