Not Responding to Treatment

I received this question recently:

“My father is suffering from AMD he has been receiving Avastin injections every 6 weeks (about 7 treatments so far) and his doctor never says he sees much improvement and he will probably need it for the rest of his life! Should we consider a different drug?(Lucentis for example) or another doctor?”

Here are possible answers:

1. I would have the doctor recheck the OCT to make sure he doesn’t have other problems in the eye like vitreous traction on the macula or an epi-retinal membrane that may need surgery.

2. I would first try Lucentis®. It works a little quicker than Avastin® but doesn’t seem to last as long. Whenever one of these drugs isn’t working, we try the other and sometimes it works better.

3. If the doctor wants to keep using Avastin, then maybe he/she should see your dad back in four weeks to make sure he isn’t missing the improvement in the fluid. Maybe your dad needs injections more often than every six weeks.

4. If your dad is not getting vision improvement and the doctor doesn’t see any reduction in the fluid, your dad may have older mature vessels that don’t respond well to these drugs. He and the doctor could consider stopping the injections to see if the vision worsens. If the vision doesn’t change much without the injections, then I would just follow him to make sure he doesn’t get worse.

5. The doctor could also consider an ancillary treatment along with the Lucentis like PDT with intraocular Kenalog along with either Avastin or Lucentis.

Unfortunately, your dad probably doesn’t have a high chance of vision improvement probably because the abnormal vessels have been there awhile. The Kenalog can increase the pressure in his eye too but usually it’s temporary so I would try one or more of the procedures listed above before giving up.

Thanks. JCF