OMG!!! It’s been almost 2 years since I last posted to my Blog. I would like to make a ton of excuses, but it might just be that life was busy, fun, and full of family and work. Honestly, I think I had lost a little bit of interest in trying to keep the public educated about eyes and everything related to their care. That doesn't mean that innovation hasn’t happened in that time. What it means is that I have A LOT of material to catch up with.
Where to start? Where to start? Ok, I’m a Retina Specialist. I treat a lot of people with a disease called Age Related Macular Degeneration (ARMD). There is a link to the educational page on this website HERE. The standard treatment for the leaking or “wet” form of macular degeneration involves injecting medication directly into the eye to try and stop bleeding or leaking blood vessels from . . . well, leaking.
These treatments help the 10% of people that have Wet Macular Degeneration, but the remaining 90% still have degeneration without leaking . . . this is usually called Dry Macular Degeneration. Some of you might have seen commercials for drugs that can treat a specific form of Dry Macular Degeneration called Geographic Atrophy. The two, current, FDA approved drugs for this condition are called Syfovre (generic name: pegcetacoplan) and Izervay (avacincaptad pegol). Each of these are drugs that are injected into the eye either every month or every other month. Their claim to fame is that after a year or two, if your macular degeneration was going to progress and possibly affect your central vision, the atrophy will not have progressed quite as fast.
Syfovre’s data shows that after two years of injections, the growth of geographic atrophy was between 18-22% less than compared to people that did not get injections. Izervay demonstrated an 18-35% slower growth rate after 1 year. Slower growth of atrophy is supposed to indicate that vision is retained longer. Seems great on paper, doesn’t it?
Just remember that clinical studies require you to read between the lines. The data presented showed that atrophy slowed down, but it did not demonstrate a meaningful retention of vision. More recent analysis of the data for Izervay might buck that trend in that they were able to demonstrate better preservation of vision after 2 years. You also must consider that these treatments require multiple injections in the eye (or eyes) to put the brakes on progression just a little. The atrophy is still progressing, so you will still lose vision over time. There are also risks associated with each of these injections including a conversion from Dry Macular Degeneration to Wet Macular Degeneration (which requires other eye injections). Finally, these medications are not cheap. Either you or your insurance are paying a substantial amount of money to cover the cost of these drugs.
So, what is my take home point? I’m not trying to dissuade you from getting these injections, but you must have a serious conversation with your ophthalmologist . . . preferably a retina specialist that understands these exceptions and risks. Ultimately, I think the pharmaceutical industry will develop a drug that really slows down atrophy well and helps save vision over time. For now, I think we are in the first versions of these types of medications. Keep taking your AREDS2 eye vitamins if your doctor has recommended that you do so and stay tuned as more news develops. Who knows? Maybe the long-term studies will show that these injections really are the answer, but I think it is too soon to decide.
Duncan Friedman
Retina Specialist
San Antonio, TX
Well, here is the "big summer project". My daughter and I had fun making a video that will hopefully give patients a sense of what to expect when they visit our clinic for the first time. Thanks to my technicians and family for putting up with me through all of this. I'm hoping that I can make more educational videos in the future now that I know how to use the video editing software.
Here is the link
My wife recently suggested this topic regarding eye care. We are in the midst of spring, and here in San Antonio that means all sorts of allergens are in the air. If the flowers alone are not enough to make you feel congested and cause your eyes to water, there is the blessing of oak pollen everywhere. I was driving to work two weeks ago (before some much-needed rain), and there was a cloud of yellow blanketing the city.
Sure, you can take antihistamine pills such as Zyrtec or Allegra, but these tend to dry your eyes out. So, what are you supposed to do if your eyes are constantly watering, itching, and irritated?
There are a few treatments available at the store. Thank goodness they are all “over the counter” and do not require a doctor’s prescription. Most drops that are available have two effects. First, they serve as an antihistamine that helps block . . . well, histamine. This substance is known to make your eyes red and watery. They also serve as mast cell stabilizers. Mast cells are the allergy cells that release a lot of other substances onto your eyes causing the irritation and itch.
The drops that I currently recommend include ketotifen (brand name Zaditor or Alaway) or patanol (brand name Pataday). Each of these can be used to help fight the allergens, but you should also make environmental adjustments to help fight off exposure to allergens in the first place.
If you are very allergic to certain pollens, dust, or molds, try to avoid contact with them. Easy to say, and hard to do if you need to get outside and do yardwork. Take it from a person that is out cutting bushes and mowing on a regular basis, those allergens get on your clothes and skin quickly. In these cases, it is a good idea to wear eye protection to keep the allergens from contacting your eyes. Further, you should try and wash off the allergens as soon as you are done with the work. Either wash your face or get in the shower to get them off as soon as you are done.
Finally, you can use drops such as lubricating tears to help flush the allergens from the skin of your eye (known as the conjunctiva). You should use these about 4 times per day if you are using drops with preservatives or as often as you need them if you use the preservative free brands.
Still, enjoy the wonderful spring weather and all the fun times ahead . . . summer is just around the corner.
Duncan Friedman
Retina Specialist
San Antonio, TX
I know, I know . . . it’s been a while. Life, family, and work are an interesting balance. Never a dull moment!!! A few new innovations have come along that are worthwhile to mention in the field of macular degeneration. I don’t think I can let these newcomers get by without writing about them just a little. Yes, I am going to try to keep updating the website blog a little more frequently than once a year.
The biggest steps forward have both come from the same company within the past few months. Genentech has released a new technology and a new medicine. Full disclosure, I do not receive any funding nor sponsorship from Genentech save for an occasional meal. This reporting is solely my opinion on the treatments and what I know thus far. I’m going to spend today’s post on the new technology and hopefully follow up soon with a discussion about the new medication.
Genentech has taken its current medication, Lucentis (ranibizumab) and made a concentrated version. This new version (SUSVIMO) can be placed in a reservoir that sits in the eye and slowly releases medication over time. The reservoir is supposed to be refilled every 6 months which is a drastic improvement from the monthly injections usually required for treatment of wet age-related macular degeneration.
The major drawback to this medication/implant is the trip to the operating room required to implant the reservoir. Although it is a relatively quick procedure that does not routinely need significant sedation, it is still a surgery and has associated surgical risks. These include bleeding, inflammation, and low eye pressure from leakage. Further, there is an increased risk of a severe eye infection after the implant is placed (2% with the implant vs. 0.3% with monthly injections), and this risk persists even after the procedure is complete. This should not be taken lightly, as the development of an eye infection, known as endophthalmitis, can lead to permanent vision loss. Still, this risk is small.
A patient with macular degeneration needs to consider whether it is worth the small risk of infection to avoid monthly injections in the eye. Also, the subsequent reservoir refills tend to cause less pain as the refill needle does not pass through the wall of the eye. It goes directly through the skin of the eye and into the reservoir. This is a substantial leap forward that is a long time in the works and has been developed with excellent research and a couple of device revisions. Admittedly, only a few have been done in San Antonio to date, but we are awaiting the first refills of these patients to see how they like it now that SUSVIMO is out in the general market.
Duncan Friedman
Retina Specialist
San Antonio, TX
So much news is coming out daily about the COVID-19 vaccines provided by different companies. At this point, we have vaccines from Pfizer, Moderna, Astra-Zeneca, Johnson & Johnson, and more are on the way. The distribution is picking up, and all adults in the United States are eligible to receive their vaccines.
The staff in my office have all been vaccinated to prevent contraction and transmission of the virus. The risk is extremely low after vaccination, but our patients tend to be older, and we do not want to risk our patients’ health. We are still all wearing masks and performing temperature/symptom checks at the door.
I have also volunteered with our local Public Health Department in their efforts to vaccinate the community. The response has been great, and I have to commend the San Antonio Fire Department in their management and staffing of the Alamodome vaccination site.
We can win this fight if everybody does their part!!! Keep up the effort.
I know it does not relate directly to eye health, but as an MD with an interest in public health, I want to see the community as healthy as possible. Good luck folks and stay healthy.
Duncan Friedman
Retina Specialist
San Antonio, TX
Dear “Fans of Eye Health”,
Just a friendly reminder that New Year’s Eve is upon us. Let’s send off 2020 with a strong, “so long; goodbye; let’s not do THAT again!” The weather will be overcast and rainy here in San Antonio, so not a great night for fireworks displays. Still, this website is accessible to anyone, anywhere. Here is the annual public service announcement from Yours Truly.
Remember that fireworks can be fun, but they also are dangerous when not handled appropriately. You should ALWAYS wear eye protection when lighting fireworks. Try and enjoy fireworks displays from a safe distance and leave the big explosions to the professionals. Even small sparklers have been associated with hand and eye trauma when not used safely. In addition, have a bucket of water or extinguisher nearby in case a fire breaks out.
Finally, well wishes to all in this New Year. May your 2021 be better than your 2020.
Duncan Friedman
Retina Specialist
San Antonio, TX
Greetings Eye Fans! Has anything interesting been happening in your life lately? As you can guess, we have been a little busy around the office and with life in general. Fortunately, the family and the team is healthy. We are riding the waves of case surges here in San Antonio and learning as we go. It seems that masks and social distancing is the best means of keeping the virus at bay.
There are so many more pressing issues and new information about the virus coming at us daily. It is a bit of news overload. I was thinking, “how does this pandemic relate to eyes and eye health.”
Here are points from an ophthalmologist’s perspective that might relate to COVID-19:
1) A small percentage of the cases of COVID-19 develop symptoms that resemble a very bad form of pink eye. Does this mean that if your eyes turn pink that you have COVID-19? It is important to try and remember that you could still just have pink eye. Check for other symptoms. Do you have a fever? Pink eye does not usually cause fever. Do you have shortness of breath? NOT A SYMPTOM OF PINK EYE. If you develop conjuntivitis/pink eye, you should probably self-quarantine and monitor for other symptoms. That’s a good idea anyway as viral conjunctivitis is highly contagious, but do not go rushing the to the hospital the instant your eyes turn pink.
2) Keep your eye appointments. At this point, I would hope that my colleagues have followed suit and reorganized their patient flow to accommodate social distancing. At our office, we check temperatures of any patient that walks into the building. Anything above 99 degrees is a warning sign, and we would prefer to reschedule patients if immediate care is not needed. Further, we ask that family members and children not accompany patients to their visits in hopes of minimizing contact. Your eye health is still very important, especially for diseases such as diabetes, glaucoma, macular degeneration, and dry eye. Missing these check-ups can result in vision loss or worsening of your eye condition. I know it can be scary to be in a doctor’s office, but try not to neglect those appointments.
3) Finally, MASK UP! More and more data is coming out to support the use of masks as an effective deterrent to the spread of the virus. If the virus does not spread, the current carriers will be the end of the road for the infection. Further, you need to wear your mask appropriately. It needs to cover your mouth and your nose, and when your doctor is examining you, do not take your mask down. That defeats the purpose. Eye doctors need to get really close to your face to do their exams with their microscopes. If you are a carrier and you take down your mask, you end up infecting your doctor who subsequently might see 10-40 more people (up close) each day thereafter. You can see how this could be a rapidly spreading problem if masks are not worn properly.
Companies are working hard on vaccines and effective treatments to decrease the damage and infectivity of COVID-19, but until we find a good treatment, you need to do your part. Most importantly, be safe and stay healthy through all of this.
Duncan Friedman
Retina Specialist
San Antonio, TX
Happy 4th of July everyone. Just a friendly reminder if you are going out to celebrate tonight that fireworks should probably be left to the professionals. Year after year, ophthalmologists see eye injuries caused by fireworks. Damage happens for many reasons. Without proper eye protection, the explosives can send projectiles into the eye which can lead to bleeding or retinal damage. Further, a firework usually contains chemicals that can cause severe corneal burns and leave the eye without sight.
Whenever setting off fireworks, you should wear wrap-around eye protection and appropriate hand protection (there are a lot of hand associated injuries as well). Never aim a firework at another person. Finally, if you have the option, enjoy the fireworks from a distance. There are plenty of beautiful displays put on by professionals every year. This is probably the best way to appreciate fireworks while staying safe. It doesn’t hurt in the time of the Coronavirus pandemic to try and socially distance and see the shows from afar.
Duncan Friedman
Retina Specialist
San Antonio, TX
I often have patients that are worried that their eyes are being “used too much”. As I mentioned in my last post, there is such a thing as eye strain due to overuse of computers and other screens. But, are screens harmful?
One line of thought is that the blue light emitted from screens and other devices can cause damage to your eyes. There are even companies that sell “computer glasses” to minimize the effects of the blue light. The reality is that we are exposed to blue light in many ways throughout the day. One of the main sources of blue light is sunlight. Along with fluorescent light bulbs and other lights, we receive a fair amount of blue light exposure without significant harm.
Currently, the American Academy of Ophthalmology has not found evidence to suggest that special glasses should be worn to minimize blue light exposure.
This is not to say that all screens are harmless. Although the blue light that comes from the screens does not cause direct damage to the eyes, your brain is affected by this light. Many phones have a “nighttime” mode which shifts the spectrum of light away from the blue wavelengths. Research has shown that exposure to blue light close to bedtime can interfere with sleep patterns. Poor sleep is associated with poor health. For this reason, I advocate to stop screen time approximately 30 minutes before bed.
A future post will address screens and how they affect children’s eyes, but for now, the take home point is that Blue Light from screens is not damaging your vision.
Duncan Friedman
Retina Specialist
San Antonio, TX