What will happen to retina if/when anti-VEGF drops arrive?

[drboruto]

Hey everyone, I recently shadowed a retina specialist and it seemed like intravitreal injections are a huge part of their day-to-day. I was wondering what will happen to the field if equally effective anti-VEGF drops are developed?

---

Members don't see this ad.

 

[DrZeke]

I will take a lot more vacations without concern that someone will miss their shots.

 

[RetinaDude]

I’m retina and have ZERO concern about this. Also, there’s A LOT of research out there. How to effectively get a high enough dose to the sub retinal space, via drops, is not even on the horizon. Geez, it doesn’t even work effectively for dry AMD yet. And, I recall there being a concern about drops being used to cure cataracts since I was a first year ophthalmology resident......and that was 25+ years ago. If you choose to skip out on ophthalmology because of a concern like this, you will miss great opportunity.
Truthfully, I’m not sure I’d even use it. Not because of money reasons but because I don’t trust pts to be compliant. It’s one thing to miss your blood pressure pill, or diabetes med, but you skip your eye medicine (for a disease like nAMD) and your vision may be screwed. Patients cannot even take their one or two glaucoma meds, despite knowing failure could/will lead to blindness.

 

[MstaKing10]

Will still need to monitor and rescue patients that don’t respond. Not sure drops will be the next big thing but eventually we will find a longer acting agent or delivery system. So I understand the concern. But if we find dry AMD therapy we will be super busy. I think that’s more likely to happen

 

[Dusn]

The act of actually having to do the injections are the least enjoyable part of the job for me (the diagnosing part of it is more interesting). Like Dr. Zeke said, they are a pain in the butt when it comes to scheduling a multi week vacation. At some point in your career, for many of us, trying to get more free time for your family becomes more important than trying to make more money.

Honestly I worry more about how much my life would suck if we had to start doing intravitreal injections for dry AMD + wet AMD. (And if we end up having to do twice as many injections, be assured that they would simply cut the reimbursement for each one in half = twice as much work for equal pay). Healthcare reimbursement is a zero sum game.

 

[Slide]

Drops are a long way off. Even if they do come, there are still tons of things in our practice that require injections. There's plenty of things for us to see that keeps us busy and active.

 

[RetinaDude]

DUSN, I’m with you about the potential chaos that would be created if, and when, we also have injections for dry AMD. Already, the injections for wet AMD feel like they multiply like rabbits because there’s more and more every day. I’m too busy doing those. There’s no way I could accommodate adding dry AMD injections as well.

 

[MstaKing10]

DUSN, I’m with you about the potential chaos that would be created if, and when, we also have injections for dry AMD. Already, the injections for wet AMD feel like they multiply like rabbits because there’s more and more every day. I’m too busy doing those. There’s no way I could accommodate adding dry AMD injections as well.

Better figure it out or other "providers" will start doing it for us

 

[RetinaDude]

Better figure it out or other "providers" will start doing it for us

If it’s in the next 5-8 years, or around the time I’m 60 years old, then I will likely be retired and sitting on a beach in Destin or Hilton Head. I’ll let someone else figure out the chaos

 

[Fascia Lata]

Hey everyone, I recently shadowed a retina specialist and it seemed like intravitreal injections are a huge part of their day-to-day. I was wondering what will happen to the field if equally effective anti-VEGF drops are developed?

In glaucoma, we are trying to move from drops to injection - not the other way around. This is not how this works. You want to minimize relying on patients’ compliance, particularly in the elderly (who have AMD and glaucoma), so drops are a terrible idea that won’t go too far, in the unlikely event that they will be developed to begin with.

 

[DrZeke]

If it’s in the next 5-8 years, or around the time I’m 60 years old, then I will likely be retired and sitting on a beach in Destin or Hilton Head. I’ll let someone else figure out the chaos

I love that you are called "dude" but are turning 60 in a few years. You are a dude after my own heart.

 

[percyeye]

Could these drops be used as a supplement to injections? Start the first injection and start a drop that would push out their next injection to 3-4 months instead of another month?

 

[RetinaDude]

I love that you are called "dude" but are turning 60 in a few years. You are a dude after my own heart.

I guess I watched too much Fast Times at Ridgemont High growing up

 

[RetinaDude]

Could these drops be used as a supplement to injections? Start the first injection and start a drop that would push out their next injection to 3-4 months instead of another month?

I just do not have much faith in the use of drops, ever. Even glaucoma seems to be heading toward more laser/minimally invasive surgery, than drops

 

[EyeGuy15]

This whole thread is rather disturbing.

Drops will NEVER be the standard of care for vegf-related diseases.
First of all, millions and millions of dollars are spent on research so that glaucoma patients DON'T have to use daily drops, due to issues with patient compliance. Compliance of daily use eyedrops is a HUGE problem.

More importanly, the amount of medicine that reaches the vitreous cavity from a TOPICAL drop is miniscule aka not very effective.

Any ophthalmologist that thinks anti-vegf drops will be significantly efficacious needs to be banned from ever practicing again.

 

[ophtho838]

This will not be a problem, at least not anytime soon. Advances in anti-VEGF treatment are heading in the opposite direction (surgically implantable devices, gene therapy, suprachoroidal injections).

 

[hello lady!]

This whole thread is rather disturbing.

Drops will NEVER be the standard of care for vegf-related diseases.
First of all, millions and millions of dollars are spent on research so that glaucoma patients DON'T have to use daily drops, due to issues with patient compliance. Compliance of daily use eyedrops is a HUGE problem.

More importanly, the amount of medicine that reaches the vitreous cavity from a TOPICAL drop is miniscule aka not very effective.

Any ophthalmologist that thinks anti-vegf drops will be significantly efficacious needs to be banned from ever practicing again.

Damn this post is so dramatic I heard they're going to reconsider the Golden Globe winner from last night.

 

[Dr.K124]

Damn this post is so dramatic I heard they're going to reconsider the Golden Globe winner from last night.

Drama is funny, though!