BLOG: Ophthalmologists can help reduce burden of injection therapy
Every single patient has a treatment burden. Think about that for a moment.
As physicians, we often look at clinical trials, see an optimal treatment protocol and intend to implement it. But our interactions with patients are generally specific to the disease we are treating and completely isolated from the realities of their everyday life. For example, we often don’t factor in how long their drive is to get to our office or consider what it takes to cancel work or find child care for them to come to their appointment. And we may only have minimal understanding of other medical treatments they are also enduring.
If we genuinely want to successfully treat our patients holistically rather than just their disease, we need to reduce the treatment burden whenever possible. For example, anti-VEGF injections work exceptionally well for retinal diseases, and we are fortunate to have them. But for optimal anatomic and functional outcomes, continuous and repeated treatment is required, and it’s not easy for patients to show up frequently to have a needle put in their eye.
An adjunctive therapy that can significantly reduce the injection burden is MicroPulse laser (Iridex). It can reduce the frequency of injections and allow patients to space out their visits, even those who are at risk of progression. In a retrospective study of patients with diabetic macular edema, 19 eyes were treated only with ranibizumab, and 19 eyes were treated with both ranibizumab and subthreshold MicroPulse laser. At 12 months, the improvement in visual acuity was similar in both groups. However, the group that also received MicroPulse laser treatment required a mean of 1.7 injections of ranibizumab compared with a mean of 5.6 injections in the group that did not receive MicroPulse. At the end of follow-up, the difference had grown to a mean of 2.6 injections in the MicroPulse group vs. a mean of 9.3 injections in the injection-only group. Also, with the growing body of literature evaluating retinal thickness variability as a poor prognostic biomarker, MicroPulse may also reduce these fluctuations in patients who may have suboptimal follow-ups due to external factors.
I cannot state strongly enough what a difference this makes to patients. Potentially cutting required visits in half can have as much positive impact on their actual lives as improving their vision.
Moisseiev E, et al. Eur J Ophthalmol. 2018;doi:10.5301/ejo.5001000.