Less Is More

“Treat-as-needed” protocol successfully corrects retinal condition.

Photo by Nerissa Johnson.

Helayne Sipes

Most of the country’s state-run lottery systems use slogans such as “You can’t win if you don’t play” to entice people to buy lottery tickets. For 30 years, Helayne Sipes couldn’t win her state lottery because her job prohibited her from playing it.

“I was restricted from playing because I worked for the lottery,” Helayne says. “I worked in the human resources department for the Michigan Lottery, and it was a lot of fun, but I couldn’t buy lottery tickets.”

Helayne retired from the Michigan Lottery in 2002. A year later, she and her husband moved to Florida, where the couple dabbled in residential real estate for a while before moving back to Michigan in 2017.

The couple recently moved back to Florida, mostly to accommodate Helayne, who has been battling some health issues, not the least of which was a condition that greatly affected the vision in her left eye.

“The vision problems began in 2016,” Helayne recalls. “They didn’t have an effect on my distance vision, but anything up close became very blurry and difficult to see. I was especially having trouble reading, and I love to read.”

Thinking it might be temporary, Helayne waited several weeks before seeking help for her vision issue. It persisted, though, and thinking then that the cause might be a cataract, she visited the Center for Advanced Eye Care in Vero Beach.

“My husband had been a patient of Center for Advanced Eye Care, and he assured me that I would be in good hands there,” Helayne explains. “It turned out that I didn’t have a cataract after all, so I ended up seeing Dr. Katz.”

Adam M. Katz, MD, a partner at the Center for Advanced Eye Care, is a board-certified ophthalmologist and fellowship trained retina specialist who has more than 20 years of experience treating patients with retina and vitreous disorders.

Dr. Katz first saw Helayne in May 2016. At that time, he diagnosed her with a central vein occlusion, a retinal condition that often results in the development of fluid in the macula, or a macular edema.

That presence of fluid in the macula, which is the functional center of the retina that gives us the ability to see images clearly, can cause blurred vision, and without treatment, the vision will continue to deteriorate.

“A central vein occlusion is like a hardening of the arteries in the eye,” Dr. Katz describes. “It’s what happens when the vein that is mostly responsible for draining blood from the retina gets closed off, and any number of things can cause that to happen.

“High blood pressure is usually the main culprit, but obesity, lack of exercise, smoking and high cholesterol can be causes as well. Whatever the cause, the occlusion can lead to a development of fluid in the macula, which usually requires treatment by a retina specialist.”

Scientific Breakthrough

Photo by Nerissa Johnson.

Dr. Katz and his staff did a great job of putting Helayne at ease.

For years, retina specialists had no means of eliminating the build-up of fluid caused by a central vein occlusion. As a result, patients suffering from such a condition often lost their vision in the affected eye.

A little over a decade ago, it was learned that injections of a protein-based medication into the eye – a procedure known clinically as an intravitreal injection – can eliminate the fluid, at least temporarily and in some cases permanently.

“These injections have become the gold standard for any condition that results in a development of fluid in the eye,” Dr. Katz educates. “That includes macular edema, diabetic fluid in the macula and macular degeneration.

“Now macular edema and macular degeneration are two completely different diseases. But both result in a build-up of fluid in the macula and both respond to the same treatment. There are also three different protocols for that treatment.”

One such protocol calls for the patient to be injected once every month for an indefinite period of time. The theory behind that protocol, Dr. Katz says, is that it keeps the fluid from redeveloping in the macula.

A second protocol calls for the patient to receive an initial injection, after which the patient receives a second injection one month after the first, a third injection two months after the second and a fourth injection three months after the third.

Dr. Katz, who has performed more than 8,000 such injections, prefers to give as few injections as possible and therefore follows a third protocol, which he refers to as the “treat-as-needed” protocol.

“In that protocol, if no fluid is present a month after I give the initial injection, I don’t recommend another injection,” Dr. Katz says. “Of course, if fluid is still present, we provide another injection. But once the fluid is gone, we stop the injections.”

Dr. Katz followed that third protocol in treating Helayne, who received an injection in May 2016 and another in June 2016. She was scheduled to receive a third injection in July 2016, but due to a lack of fluid in the macula, the injection was cancelled.

Shortly thereafter, Helayne and her husband moved back to Michigan, where for nearly two years, Helayne’s condition was monitored by an ophthalmologist who, much to her chagrin, followed the first of the three treatment protocols.

A Good Move

“First of all, I want to say that Dr. Katz was wonderful,” Helayne raves. “The injections only took about fifteen seconds; they were done in a very clean, sterile environment; and he and his staff were very friendly and thorough. They did a great job of putting me at ease.

“When I moved back to Michigan, however, the experience wasn’t anywhere the same at all. It was a horrible experience, actually. The doctor there was giving me injections every month, and once, he forgot to numb my eye.

“After that, I went to another doctor, who gave me an injection after five weeks, then another after eight weeks and another ten weeks after that. That happened through the rest of 2017 and 2018, then we moved back to Florida.

“When we moved back to Florida, we moved back to Vero Beach, partially because it’s a wonderful place but also because of Dr. Katz, whom I’ve seen twice since returning. It’s been more than six months now, and I have not needed another injection.”

It’s likely Helayne didn’t need any of the injections she received while in Michigan either. Though the injections are a treatment for macular edema and not a cure, Dr. Katz believes some patients receive far more injections than they ever need.

“I’ve taken many patients who were getting regular injections and said, Let’s just hold off for a while and see if the fluid comes back,”

Dr. Katz explains. “And many of them have never needed another injection.

“Now if the fluid does come back, I’m not opposed to providing a treatment and giving them an injection. But my protocol is quite successful. Several studies show that and right now, everything is moving in the direction of not injecting people regularly.

“So I’d like people in the area to know that if they’re going to a physician who recommends monthly injections or every-two-months injections for problems like this, it might make sense to get another opinion.

“There are other options, and I believe Helayne is a good example of that. She hasn’t had an injection in more than six months, and her vision is 20/30. She’s doing great, and she’s relieved to know she doesn’t need regular injections.”

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