Since 2006, eye doctors have been recommending a high dose of antioxidants and zinc for AMD patients to reduce their risk of getting advanced AMD (bleeding at the macula). The doses of Vitamin C, E, beta carotene and Zinc recommended are much higher than our daily recommended intake and supplements have to be taken daily to get such high doses. This is based on the landmark AREDS study done in the USA which was conducted on almost 5000 patients who were randomized to receive either the high dose supplements or placebo. They were then followed up for 5 years and the patients taking the supplements were found to have almost 25% lower risk of getting advanced AMD.
There are several eye diseases that can be treated by injection of special drugs into your eyeball. These diseases are diabetic retinopathy, AMD, infections in the eye, and, retinal vein occlusion. The drugs that can be used are Avastin, Lucentis, Eyelea, steroids, antibiotics, antivirals, and antifungals. As the drugs are injected into the vitreous cavity of the eye, these injections are called “intravitreal injections”. It is now one of the most commonly done eye procedure worldwide.
Intravitreal injection is safe and painless
Many patients are often frightened at the thought of having a injection into their eye. It is actually not that bad and is less painful than having an injection in your arm. The needle that I use to inject the drugs is the smallest sized needle available(30 gauge) and the injection only takes less than 10 seconds. I also give anesthetic eye drops before hand. Many patients all over the world are having monthly injections of anti-VEGF drugs like Avastin, Lucentis, and Eyelea. It is very well tolerated and is very safe. Rare complications include infection in the eye, retinal detachment, bleeding in the eye, and glaucoma.
Prevention of infection is most important
To prevent infection after intravitreal injections, I use iodine to clean the eye throughly. Then, I use a special eye speculum to open the eyelid to prevent the eyelashes from contaminating the part of the eye that will be treated. I then prepare the drug that will be given. Before the giving the drug, I use a sterile cotton bud to move the skin of the eye (conjunctiva) away from the eyeball (sclera) and then give the injection. This means that after the drug has been given, the skin of the eye will move back over the site of the injection. This prevents the drug from coming back out and any bacteria from entering the eyeball. The patient has to use antibiotic eyedrops for 1 week. They are told to report back to me should they experience any pain or redness in their eyes as this could mean they have an infection. The overall risk of an infection is about 1 in 1000 cases. This is considered to be very small.
The most important factor is to have your treatment done by a trained retinal surgeon who can manage any complication arising from the intravitreal injection. Retinal specialists can also determine whether or not you need an injection and when the treatment has to be stopped or changed.
Have a great day!
Many people are often confused about the differences between an Ophthalmologist, an Optometrist, and an Optician.
What is an Ophthalmologist?
An ophthalmologist is a doctor that has been to medical school which takes up to 6 years. After that, the doctor has to undergo housemanship training for 1 to 2 years before he/she can apply for postgraduate medical training to become an eye specialist. This can take between 4 to 7 years depending on which country you carry out the training in. We also have to sit exams and obtain our qualifications from colleges like the Royal College of Ophthalmologists.
After one has qualified to become an Ophthalmologist, one can choose to sub-specialise further to become an expert in a particular part of the eye. It may sound crazy that we have to spend so many years just to become an expert on a tiny organ like the eye but there are actually many things to learn. A retinal specialist is someone who has completed formal ophthalmology training and then spends another 2 to 3 years learning to operate on retinal diseases like retinal detachment, macular hole, epiretinal membrane and diabetic retinopathy. This usually done in a large teaching hospital where there are senior retinal specialists to train you. So a retinal specialist will have spent almost 10 years studying and working after getting their initial medical degree.
What is an Optometrist and Optician?
An optometrist is someone who has completed a Bachelors degree to learn how to prescribe glasses and contact lenses. They can also diagnose common eye diseases but cannot prescribe medications or do surgery. Some optometrists can do further studies until they get a PhD degree and can call themselves “Dr” but they are not medically trained.
Opticians obtain their qualifications via a diploma and are trained to make and adjust spectacles and fit contact lenses. Some opticians also prescribe glasses but this is dependant on their experience.
Ophthalmologists can perform all the tasks that Optometrists and Opticians do but as we are usually too busy managing eye diseases, we often leave this job to them. A patients is usually managed by a team effort whereby the Ophthalmologist can do surgery like cataract surgery and then send the patient to the optometrist or optician to make their new glasses. In countries like USA, Optometrists are fighting to have rights to prescribe medications and do surgery on patients and this has implications of the safety of patients as these optometrists do not have any formal medical training and cannot manage the patient as a whole taking into account their other diseases.
Thanks for reading and have a great week!