There are at least two ways that VEGF affects blood vessels;

1. VEGF induces the production of new (albeit abnormal) blood vessels, as in the cases of proliferative diabetic retinopathy and wet macular degeneration.
2. VEGF also causes normal blood vessels to become leaky…as is the case in diabetic macular edema. The normal retinal vessels are not as “water tight” as they used to be…hence leading to edema.

Did this work? Great astute question.

Randy

Thanks for the quick response. Congratulations on the AAO invite!

I had one additional question about my PDR. After PRP treatment and stabilzation, can Avastin be used as a preventative measure due to it’s anti-VEGF properties, assuming PRP cured the ischemia? I understand that I will be seeing a retina specialist every 1-2 months with or without the Avastin injections.

Also, I wish all my doctors were as transparent as you.

I would suggest, based on this comment and your previous comment, that you get Avastin just prior to surgery. This is my opinion only. I generally will inject (in cases where I suspect significant bleeding) about 1 week prior to the surgery.

What really matters is the degree of traction present now…if any. Bleeding and traction do not always go hand in hand.

Randy

In answer to your questions;

1. I don’t know that you can find a doctor familiar with using Avastin as most people (docs) don’t maintain blogs like this. I do know that Avastin for PDR is a temporary fix and the ultimate, more likely fix is PRP.

2. Not aware of any studies to link for you.

3. I would be happy to assist you in any way possible. Just let me know. I do think you should be able to find someone up there to help you.

Randy

The medical literature I’ve been able to find seems to imply that Avastin is less likely to cause these complications, and the scarring from laser is more likely to cause TRD.

I have proliferative diabetic retinopathy in both eyes, and my doctor has given me PRP laser treatments about every 3 months for about a year. According to my doctor, new vessels have not been forming, however my right eye has been clouded with blood for 2+ months and I recently had a minor hemorrhage in my left eye. The current plan is to repeat the PRP laser and then wait.

I got a second opinion. Victrectomy right eye. Extensive additonal laser in left eye. Both doctors feel that Avastin is not a proper treatment for PDR, but at least the second doctor said he would give me Avastin shots if that’s what I want him to do.

I may see about visiting your office, however I live 8 hours away. Before I commit to having a doctor that far away, I was wondering if I couldn’t find someone in my area Dayton/Cincinnati.

I have 2 questions. How can I find a doctor familiar with using Avastin after laser. Or, do you have any advice on how to get my current doctor to evaluate the recent studies & medical data on using Avastin?

I hope you are feeling better.

I will ask my office to make sure that you are rescheduled. Hope to see you soon!

Randy

I have proliferative diabetic retinopathy in both eyes, and my doctor has given me extensive laser treatments in my right eye as it is showing a partial retinal detachement that he says will detach if not treated.

He has me scheduled for invasive surgery to fix this problem, but after reading this, am wondering if the Avastin injections coupled with the laser eliminate the need for the invasive surgery (Victrectomy), though I am not clear whether there is a partial detachment, or he feels if not operated on, a detachment will occur.

I am having Avastin tomorrow, and then the surgery Friday (today is Tuesday).

I have an appointment with your office for a second opinion but my insurance will not pay. I missed the apt with you, but do want to see you and my family has agreed to pay for the second opinion. What do you suggest? Thanks so much.

I was very ill and could not make the appointment, so hopefully my brother called your office and cancelled for me as I asked him to do. Thanks so much!

There are two treatable components to diabetic retinopathy; swelling and neovascularization. Both can be treated with Avastin and/or laser. In other words, is your doctor recommending more laser for swelling, or more laser for neovascularization?

Avastin is given as often as monthly for macular degeneration. In patients with diabetic retinopathy, it does not need to be given as often, but it depends on each case.

As your doctor if he wants to be treating the macular edema with Avastin, or, proliferative diabetic retinopathy.

Thanks for asking.

Randy