This article is more than 5 years old. Information may no longer be current.
Anti-VEGF therapies may provide practice growth for comprehensive ophthalmologists
Click Here to Manage Email Alerts
Anti-VEGF therapies may provide practice growth for comprehensive ophthalmologists
by Richard L. Lindstrom, MD
 Richard L. Lindstrom |
Anti-VEGF therapy has already revolutionized the treatment of several retinal diseases, including exudative age-related macular degeneration, central retinal vein occlusion and branch retinal vein occlusion. It is showing promise in the management of diabetic retinopathy, especially when associated with cystoid macular edema, and retinopathy of prematurity. Each of these retinal pathologies, except the last, is age related, and the incidence of each can be anticipated to grow significantly over the next 3 decades as our population ages and our patients live longer.
The good news is that many more of our seniors will enjoy good vision in their later years. The bad news is that the demand for these services is going to put a significant strain on our ability to afford and provide the service. If one makes the assumption that anti-VEGF therapy is proven superior in most cases of exudative AMD, vein occlusion and diabetic retinopathy and that injections must be repeated several times per year, it seems impossible that all of this care can be provided by our already very busy cohort of retinal specialists. An expanding group of ophthalmologists well-trained in medical retina would help serve this almost certain need.
I believe it will be imperative for a significant number of comprehensive ophthalmologists to focus on the growing need for expertise in intravitreal anti-VEGF therapy, which is also an opportunity for them to expand their practice. To provide the highest quality care, significant additional training will be appropriate, and this training will be best provided by retinal specialist experts in the field. The demand has not yet put our retina colleagues on their knees, but it is time to start planning for a way to provide the high volume of care that will be necessary in the coming years.
On the innovation and technology side, the development of extended-release drug devices will ultimately be a great help. They will benefit both the ophthalmologist and the patient, reducing the frequency and invasiveness of repeated intraocular injections. However, in our current regulatory environment, approval of these devices is uncertain and years away.
Anti-VEGF treatments can and usually are cooperatively managed between retina specialists and comprehensive eye ophthalmologists. The key issues in post-injection care that require monitoring include endophthalmitis, elevation of IOP and recurrence of disease. Recurrence of disease is best evaluated with the help of optical coherence tomography, and it is likely that most comprehensive ophthalmologists will find this an indispensable tool in their practices. It is time for all practices without OCT to start planning to acquire one. Again, quality education by our retinal colleagues in the proper interpretation of OCT images will be important to achieve the maximum benefit for our patients. Fortunately, OCT will also improve our quality of care for our glaucoma patients, making it easier to justify the acquisition cost.
Finally, anti-VEGF therapy has promise in the treatment of anterior segment disease as well. Especially promising are a possible role in glaucoma filtration surgery and the management of pterygia. Corneal vascularization is another possibility, but the benefits to date for this potential indication seem too transient for meaningful benefit. Patients being treated with anti-VEGF therapy are now part of almost every ophthalmology practice, and it is important for us all to become and remain well-educated as this new field of therapy is exploding in indications and volume of treatments. For some, the expanding need for anti-VEGF treatments will present an interesting opportunity for practice growth.