Intravitreal Injections Versus Laser for Macular Disease By: Kenneth WaLs, M.D. Retina specialist, aran eye associates

During the past few years there has been an explosion in the use of intravitreal injections for numerous macular diseases. In fact, during the past decade, the intravitreal injection has seen the largest increase in use in all procedural codes in all of medicine. so, what are the pros and cons of intravitreal injections versus lasers in general, and are they actually a better treatment for each of the macular diseases they are supposed to treat?

Pros/ConsFirst off, intravitreal agents, unlike laser, treat the disease without destroying part of the macula; with laser treatment, tiny burns are made to both the retinal pigment epithelium (RPe) and retina. therefore, an unlimited number of intravitreal injections can be given. With laser, you eventually run out of areas that can be lasered.second, as we will see later, the treatment results are excellent, and have revolutionized the outlook of various macular diseases.On the other hand, the risk of endophthalmitis and retinal detachment, though rare, can have a devastating effect on the eye. the only real risk with macular laser is of the patient looking in the wrong place during the procedure, resulting in a laser burn in the fovea with subsequent scotoma. In experienced hands, however, this will not occur.One other drawback is that, until now, intravitreal injections have a relatively short duration of action (usually only 4-6 weeks), so that numerous repeat treatments are necessary. Laser treatment can often have a permanent effect. the original concern that intravitreal anti-VeGF (vascular endothelial growth factor) agents lead to higher rates of cardiovascular events such as stroke and heart attack have not, fortunately, borne out in other studies.

Macular Degenerationsince the introduction of Lucentis and avastin, the results have been excellent, showing that, for the first time, the average patient with newly active choroidal neovascularization (“Wet” aMD) improves vision with intravitreal injections of these agents. this was not true during the age of thermal laser, photodynamic therapy (also laser), or even intravitreal Macugen, where patients undergoing treatment would only lose vision less quickly than without treatment.

Retinal Vein Occlusionagain, recent studies have shown that intravitreal Lucentis (and probably avastin) are far superior to laser in improving vision in patients with macular edema due branch retinal vein occlusions versus laser. In fact, with these injections, more than 50% improve visual acuity by at least 3 lines. Intravitreal corticosteroids have shown some benefit versus laser, too, but not as robust of a difference. Laser treatment for macular edema in central retinal vein occlusions is not effective, so the robust visual improvement seen with anti-VeGF agents is a huge plus in our ability to treat this disease.

Diabetic Macular edemathis is the most recently evolving treatment strategy, as results from studies are beginning to be published. Intravitreal corticosteroids thus far have not shown any benefit over retinal laser. however, with intravitreal Lucentis and avastin, it appears that, for the first time, we can talk about patients on average gaining vision with treatment versus merely stabilizing vision with laser treatment.

SPRING 2011

www.araneye.comwww.tlccoralgables.com

Aran Eye Associates will host the 16th Annual Island Retreat on August 12-13, 2011

at The Casa Marina Resort, Key West, Florida The continuing educational seminar will offer four lectures providing the attendee the opportunity to complete 8 hours of TQ quality CE credits. The lectures are held from 8:00 am - 12:00 pm Friday and Saturday.

Speakers and Lectures:

J. James Thimons, o.D., FaaoClinical Update 2011

Advances in Anterior Segment Therapy

anDrew s. morgensTern, o.D.Refractive Surgery Complications and How to Deal with Them

Optometric Glaucoma: Monitor, Treat or Operate

Allergy Season Presents an Opportunity for Discussing LASIK with your PatientsPatients suffering from allergies complain about red, itchy eyes throughout the day, conjunctivitis and rhinitis, or runny nose. Contact wearers suffering from allergies are also subject to giant papillary conjunctivitis and rarely want to give up wearing their contacts for any period. Discussing LASIK with these patients will provide a solution for the constraints and discomfort of wearing contacts during allergy season and beyond.

2011 CUSTOMIZABLE ALLERGY MATERIALS

Call your PRC or Local Center to order.

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LASIK can’t stop your allergies, but it can help reduce or eliminate your dependency on contacts. We are dedicated to providing the very best care available. That’s why we’ve chosen TLC Laser Eye Centers®, a leader in LASIK, for our patients who want to improve their vision beyond glasses and contacts.

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Join us for our LASIK Seminar! Do Your Glasses or Contacts Bother You with Your Allergies? Have LASIK at TLC Today!LASIK can’t stop your allergies, but it can help reduce or eliminate your dependency on contacts. We are dedicated to providing the very best care available. That’s why we’ve chosen TLC Laser Eye Centers®, a leader in LASIK, for our patients who want to improve their vision beyond glasses and contacts.

Save $000 with a TLC LASIK Gift Card.Schedule your LASIK procedure by May 31, 2011 to take advantage of this offer.

Financing Options to fit your budget

Pay for your procedure over time with low monthly payments that fit easily into your budget.*$000 Savings ($000 per eye) valid on Bladeless Custom LASIK only. Gift card can be used only at participating TLC centers. Patient must complete their procedure by May 31, 2011. Gift Card must be provided to TLC at time of surgery. Discount cannot be used if a procedure is already scheduled at a TLC location. Cannot be combined with any other discounts or special offers, previous surgery, insurance or vision care plan savings. Call your eye doctor or 877.TLC.2020 to schedule your FREE LASIK Consultation.

Wishing for LASIK?

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LASIK can’t stop your allergies, but it can help reduce or eliminate your dependency on contacts. We are dedicated to providing the very best care available. That’s why we’ve chosen TLC Laser Eye Centers®, a leader in LASIK, for our patients who want to improve their vision beyond glasses and contacts.

Save on LASIK!

$000* Offer Ends 5/31/11

Save $000 with a TLC LASIK Gift Card.Schedule your LASIK procedure by May 31, 2011 to take advantage of this offer.

Financing Options to fit your budget

Pay for your procedure over time with low monthly payments that fit easily into your budget.

*$000 Savings ($000 per eye) valid on Bladeless Custom LASIK only. Gift card can be used only at participating TLC centers. Patient must complete their procedure by May 31, 2011. Gift Card must be provided to TLC at time of surgery. Discount cannot be used if a procedure is already scheduled at a TLC location. Cannot be combined with any other discounts or special offers, previous surgery, insurance or vision care plan savings. Call your eye doctor or 877.TLC.2020 to schedule your FREE LASIK Consultation.

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Please call The Laser Center of Coral Gables for additional marketing tools that can assist you in educating your patients and growing your practice with LASIK.

LASIK posters displayed in the lobby area of your practice can assist in reminding the patients of the freedom of seeing clearly without the constraints of wearing contacts or glasses.

LASIK brochures offered at your practice serve in educating your patients and increasing communication that you have a progressive practice. Patients often take LASIK brochures to discuss with friends and family. LASIK discussions with patients often lead to them telling their friends and family members, which can boost word of mouth referrals to your practice.

Lead cards are an excellent vehicle in opening a LASIK conversation prior to the patient’s chair time.

Gift cards provide the patient with an incentive and diminishes the cost barrier when making a decision towards LASIK surgery.

Please contact us at The Laser Center of Coral Gables at 305-461-0003 or call our Director of Marketing Gloria Ayan at 305-491-3747 for more details of how to implement these great tools into your progressive practice.

SAVE THE

DATEAugust 12th & 13th