Wait And See

Eye injections halt progression of macular degeneration, prevent vision loss.

The city of Meadville is nestled in Pennsylvania’s beautiful French Creek Valley, about 90 miles north of Pittsburgh. As a longtime journalist for the daily Meadville Tribune, Connie* knows the community well. 

“Meadville is a small city of about 13,000 residents,” Connie reports. “It was founded in 1788 as the first permanent settlement in northwestern Pennsylvania, and it serves as the county seat for Crawford County. It has an excellent public school system and is home to Allegheny College, one of the nation’s top liberal arts colleges. 

“Meadville has many parks, trails and gardens to explore. It’s a wonderful place to enjoy nature. It also has museums and a historic downtown, as well as a theater that hosts a variety of artistic and cultural events, concerts and plays. The city has its share of problems, but basically it’s a great place to live and raise children.”

By 2015, Connie was finished raising her children, so she opted to flee the harsh Pennsylvania winters and head to Florida. She greatly appreciates the balmy climate of the Sunshine State. She plays golf and pickleball several times a week and spends hours lounging on her lanai with her favorite reads: true crime novels. 

Two years ago, 61-year-old Connie was enjoying one of those novels when she suddenly realized she was struggling to see what she was reading. The vision in her right eye was blurry, and the printed words in her book were distorted.

“I immediately went to my eye doctor, who didn’t like what she saw when she examined me,” Connie remembers. “She said there was a problem with my retina.”

The retina is the light-sensitive layer of nerve tissue that lines the back of the eye. It converts light into electrical signals and sends them to the brain, which interprets them as images.

The eye doctor referred Connie to Florida Retina Institute, where she met with Thomas A. Barnard, MD, a board-certified, fellowship-trained retina specialist. Dr. Barnard examined Connie and discovered that scar tissue had formed on the retina of her right eye. 

“Using a surgical procedure, we successfully peeled away the scar tissue from Connie’s retina,” Dr. Barnard reports. “Unfortunately, she then developed another issue in her right eye: wet macular degeneration. The retina surgery had nothing to do with Connie developing macular degeneration. It wasn’t the cause of it. It was just coincidental.”

Preventing Vision Loss

Macular degeneration is a progressive breakdown of the macula, the center portion of the retina responsible for central vision. It generally occurs in people older than 40, so the condition is also called age-related macular degeneration, or AMD. 

There are two types of AMD: dry and wet. Dry AMD occurs due to natural degenerative changes to the retina and macula. The most common symptom of dry AMD is blurry or distorted vision; straight lines may appear wavy, for example.

“With wet AMD, the body tries to grow blood vessels to help nourish the degenerating tissue in the back of the eye,” Dr. Barnard explains. “However, these blood vessels are abnormal and leak into the retina, destroying central vision. In addition to blurry or distorted vision, wet AMD can also cause dark spots to form in the field of vision.”

It’s important to find AMD early when treatment is most effective and severe vision loss can be prevented, Dr. Barnard stresses. 

“When we discover dry AMD, we start patients on a special vitamin formulation called AREDS2, which reduces the risk of disease progression,” the retina specialist educates. “It’s even more important to catch wet AMD early because there’s only two or three weeks after the abnormal blood vessels start to grow before damage to the retina begins, resulting in vision loss.

“When people start noticing blurriness or distortion in their vision, where straight lines don’t look straight, they should seek an evaluation from a retina specialist right away.”

Retina specialists typically begin their evaluation for AMD with a dilated eye exam. This exam provides a clear look at the back of the eye.

“We also use optical coherence tomography, or OCT, which is an imaging technique that measures the thickness of the retina,” Dr. Barnard details. “OCT can detect early changes to the retina, as well as swelling due to wet AMD.

“In addition, we may perform fluorescein angiography. During this procedure, a dye is injected into an arm vein and travels through the bloodstream to the blood vessels in the eyes. It enables us to map out normal vessels and find abnormal vessels that may be forming.”

Treatment for wet AMD involves injections into the eye of medications that block vascular endothelial growth factor (VEGF), a protein made by the body that triggers the growth of new blood vessels. Anti-VEGF medications suppress the formation of vessels that become abnormal and lead to wet AMD.

There are three FDA-approved anti-VEGF medications used by the specialists at Florida Retina Institute: bevacizumab (brand name AVASTIN®), ranibizumab (LUCENTIS®) and aflibercept (EYLEA®).

“These medications only stay inside the eye for a certain amount of time before the body flushes them out,” Dr. Barnard states. “Therefore, anti-VEGF injections must be given continually at certain intervals. Each patient is different, so the interval between injections is specific to the patient.”

“Painless” Injections

Connie is currently receiving injections of EYLEA into her right eye every six weeks. She reports that she’s “doing really well” with the treatment.  

“I’m pretty happy with my results so far,” Connie enthuses. “My vision isn’t perfect, but it’s a lot better than it was before I started the injections. And it’s been holding steady for two years. Dr. Barnard has been able to minimize the damage to my retina from the AMD and halt further vision loss.”

Connie is also thrilled with the people responsible for her treatment.

“Dr. Barnard is awesome,” she raves. “He’s very knowledgeable, kind and compassionate. He explains everything to me in terms I can understand, and I appreciate that. Dr. Barnard always makes sure my eye is good and numb before injecting the medication so the injections are painless.

“The staff at Florida Retina Institute is wonderful. Everybody is friendly and welcoming. They don’t treat me like a number; they treat me like family. I highly recommend Dr. Barnard and Florida Retina Institute.” 

© FHCN article by Patti DiPanfilo. mkb
*Patient’s name changed at her request.
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    • Florida Retina Institute

      Founded by James A. Staman, MD in 1979, Florida Retina Institute has 19 locations throughout Central Florida, North Florida, and Southeast Georgia. They have proudly delivered Excellence in Vitreo-Retinal Diseases and Surgery for 40 years. T... Read More

    • Thomas A. Barnard, MD

      Thomas A. Barnard, MD, is board-certified by the American Board of Ophthalmology. He earned a Bachelor of Science degree from Stetson University in DeLand and a Doctor of Medicine degree from University of South Florida in Tampa. After gradu... Read More