“My First Avastin Injection:” A Patient Account

A couple of months ago, I examined a new patient who had been complaining of decreased vision, and distortion, in the right eye for about 2 months.  His vision was 20/200 in the right eye.  After examination, I recommended  Avastin® treatment for his wet macular degeneration.  This is his account of the injection and the weeks after.

Saturday, 12/5 I was administered the shot of Avastin at about 12:49 pm. I was first given about 4 Q-tips of topical anesthetic. The Avastin was then administered. I felt no pain when the needle entered, but I felt a not-too-s pressure. Soon thereafter, I suspect when the drug was “pushed’ out of the syringe, I did feel slight pain for about 1 second or so.. The fact that I felt some pain worried me, more that the slight pain itself, likely because of where and how I felt it….a NEEDLE in my EYE, knowing I couldn’t move. The pain disappeared immediately after about 1 second. After the needle was removed, I felt no pain whatsoever. Soon after leaving the office, I felt a significant irritation in my eye, similar to what one would experience with a more than mild seasonal allergy. There was slight burning, but NOTHING what one might say would approximate any kind of pain, For the next few hours it persisted, then it went away. Perhaps it was because of a post-procedure antibiotic. The rest of the day my eye was irritated, but nothing more that the feeling one might have when the eye is scratched when taking out a contact. I did feel some slight pressure/swelling of the eye afterwards, throughout the day, but, again, no pain. I went to bed at about 11:45 pm on Sat.

Sunday, 12/6 I woke up on Sunday at about 8:30, My eye felt normal. I did not have a contact lens in the subject eye since the night of Friday, 12/4. I looked in the mirror, and it visually appeared to look normal. I got my act together, then went downstairs. I closed my good eye, to see how the subject eye was performing. Without considering the distortion issue which brought me to Dr. Wong, the “clarity” of vision in that eye “seemed”, and “seems”, noticeably improved, without my contact in. Lines seem more defined and crisper.

As to the distortion, my sense is that it is already improved, although it is still definitely present. I note, however, that it seems less “bothersome” to me on a minute-by-minute basis. I am writing this shortly thereafter…at 9:36 a.m….only 21 hours after the procedure that administered the drug. It is possible that my perception is psychological, or that it is difficult to judge comparatively since my eye was irritated until I went to bed last night, but my “sense” is that the distortion is actually improved from the starting point. Overall I would rate my vision in the subject eye as already being better than before I underwent the procedure.

Monday, 12/7 Upon wakening this morning, and for 2 hours thereafter, I noticed no change in my vision from Sunday.

Tuesday, 12/8 I noticed no change in my vision an hour after my 6:00 a.m wake up

Wednesday 12/9 – 12/13 No discernable difference in my vision

Sunday 12/13 My impression is that there seems to be some slight improvement in the distortion, but it is not possible to accurately define.

Wednesday 12/15 I notice that I am able to read large type better than before, but small type is not possible. The distortion seems the same since yesterday

Saturday 12/19 In the shower this morning, I had the strong impression that my distortion is much better. There is still distortion, but it seems much less significant than before. When I close my left eye, there is what I feel is excellent clarity, but still some distortion.

Friday 1/1 I noticed in the shower that my distortion seems improved again. Things don’t seem as slanted with my right eye, as compared to my left eye (with right eye shut).

Friday 1/8 My impression is that the distortion is improved again, but it’s hard to explain “how”. I suppose, it’s just a bit less severe.

Wed 1/13 No discernible change…………

_______________________________________

Sat 1/23

Got another shot yesterday. They left the anesthetic on longer before the shot. I had no pain during the shot, but it was pretty uncomfortable. No big deal. The shot was quick. Had burning and watery eye for next 3 hours, then much better. Woke up this morning, and for the first ½ hour I forgot that I even had a shot yesterday.

Put the contact lens in about 9:30 am. All systems are go. Eye feels a touch tender, but a total non-issue.

I notice no change in my vision from before the shot yesterday.

****************************

What Does This Mean? The second shot was administered last Friday.  Vision had improved from 20/200 to 20/40 in just six weeks!  In all the literature, you never read anything from the patient’s perspective.  I find it interesting that my patient noted changes in the vision almost immediately and that these changes continued for the first month.  A third injection is planned in another 6 weeks.  I suspect that the vision will continue to improve, especially the distortion, based on the location of the neovascular tissue;  it is just to the side of the macula.  Once the nevascular tissue has regressed, additional injections may be needed for “maintenance.”

“Randy”

Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia

Comments

  1. Dear Collin,

    There must be some leakage or change in your vision? I am afraid I can’t offer much insight to this as I don’t have enough information from you.

    Randy

  2. A question please……if I may.

    I was diagnosed with AMD wet type in my right eye in November 1911. I read that a doctor in Florida just some 6 years ago or so used Avastin injections to treat his patients for Macular Degeneration. Not sure of the Dr.’s name but I think the name was Rosenfield.
    This treatment cost the patients just $18 NOT $1,800 which Lucentis injections cost. The doctor treated 73 patients only giving 3 injections resulting in a total cure. If I can find a doctor involved in this treatment I would be willing to seek his help. I am 79 and am a fairly active person. I am hoping someone who reads this message could help me with locating a doctor who would treat AMD. I live in Norwalk, Connecticut and due to my age I am a little restricted in my movements…traveling away from home. Will you kindly…anyone who is inclined to want to help me in this matter, please email me as shown above that is: joefarrugia33@aol.com Thanking you all in anticipation. Joe

  3. Dear Joe,

    1. Rosenfeld
    2. Avastin is about $35-$50.
    3. Total cure is not really possible, but it’s what we’d all shoot for.
    4. There should be a retina doc near you who routinely uses Avastin for wet ARMD. By the way, do actually have wet ARMD?

    Stay in touch.

    r

  4. Dear Dr. Wong,

    I have had had myopic macular degeneration for twenty years. Between 1992 and 2000, I had 5 retinal hemorrhages, affecting both eyes, which were successfully treated with laser. I was symptom free for 12 years then, a couple of months ago, I had another bleed. This time I was given an Avastin shot. The bleeding cleared, but I have been left with some significant ‘blind spots’, which my surgeon attributes to retinal atrophy, not the Avastin shot itself.

    As I have had this disease for many years, I understand that retinal atrophy may have been present for a while, but I’ve never noticed its effects until now. I find it too much of a coincidence that I had the Avastin, then two weeks later noticed the ‘blind spots,’ which have worsened my vision considerably. It is possible that the Avastin has triggered this situation? I need to know because there is a possibility that I might need more shots in the future.

    Thanks in advance for your insights.

  5. Dear Dr. Wong,

    I have had myopic macular degeneration for twenty years. Between 1992 and 2000, I had 5 retinal hemorrhages, affecting both eyes, which were successfully treated with laser. I was symptom free for 12 years then, three months ago, I had another bleed. This time I was given an Avastin shot. The bleeding cleared, but I have been left with some significant ‘blind spots’, which my surgeon attributes to retinal atrophy, not the Avastin shot itself.

    As I have had this disease for many years, I understand that retinal atrophy may have been present for a while, but I’ve never noticed its effects until now. I find it too much of a coincidence that I had the Avastin, then two weeks later noticed the first blind spots, which appear to be progressing and have worsened my vision considerably. It is possible that the Avastin has triggered this situation? I need to know because there is a possibility that I might need more shots in the future.

    Thanks in advance for your insights.

  6. Dear Kathy,

    Perhaps you received the shot too late? I don’t know. It’s a possibility. I don’t think the Avastin itself would do that. Could you get a second opinion?

    Randy

    Randall V. Wong, M.D.
    Ophthalmologist, Retina Specialist
    Fairfax, Virginia
    http://www.TotalRetina.com
    http://www.RetinaEyeDoctor.com

  7. Dear Kathy,

    Please refer to my answer located on the other thread.

    Randy

    Randall V. Wong, M.D.
    Ophthalmologist, Retina Specialist
    Fairfax, Virginia
    http://www.TotalRetina.com
    http://www.RetinaEyeDoctor.com

  8. Dr Wong,

    I am 36 years old , high myopia -14 D in both eyes.

    I started seeing distortion with my right eye , been 3 weeks , my last visit to my RS was 3/27 . I got AVASTin shot in left eye as there was fluid leak. They did OCT scan for both eyes. Last 2 visits 3/14/14 and 3/27/14 I mentioned to my RS about the waviness i noticed in my right eye , which I didn’t had at all until 3/14. He says he cannot treat me right now. its not going to help me as OCT scan shows normal.

    I was checking with Amsler grid everyday since feb2013. My right was perfect no waviness at all until 3/14.

    Do you think the machine missed to capture the leak in my right eye?

    If my RS waits until it shows on OCT scan and then treat my right eye will the waviness go away with the shot?

    will it harm to get a shot in right eye as already seeing wavy?

    With my left eye I already see wavy , because i have scars from previously untreated abnormal blood vessel growth.

    I just to be safe and save my right eye.

    Any help is appreciated. Thankyou
    Please

  9. Dear Sheila,

    Can’t really tell. Many things can cause distortion. A fluorescein angiogram, however, might be very helpful in this instance. Ask your RS about this.

    Randy

  10. Had avastin shot . The third one hit a vein blood in my eye. Got shot wed. Still looks same. TODAY Friday. Retina Dr. said like a bruise they hit vein I have also had two laser and cataracet surgery implant. in this eye(right eye. Two laser and two shots in left eye. First time this happen They want to do laser in two weeks .For some reason they wanted to do laser and shot at same time . Different person doing procedures. I told them I did not want both at same time.I think that was a good choice after what happen with shot.How long should This blood last in my eye. Now is it safe to have laser and more shots since they bruised my eye. Does this happen very often hiting vein .I have diabeties Ret., swelling edma . I am 65 yr old woman. My eyes are worst.

  11. Betty,

    Is the blood on the outside of the eye? For what reason is laser being considered?

    Are you diabetic?

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  12. Yes I am Diabetic. Have edema bad in right eye. Two laser in each eye. They say laser for bleeding. Last time new person at center said more popped up. I was told by a friend their retina Dr. does not do laser for this reason. More pop up. I wonder if I made a mistake by letting them do this laser.. Now the Avastin shot has bruised my eye. Looks like blood in eye covers white eye on side gave shot. It has been six days eye still blood red. I don’t know how long this should last. II went back day after shot they said they hit vein. Brused my eye. I was suppose to go back in two weeks for laser treatment. This will be third laser in this eye was my third shot. My optomaligst did cataract surgery on this eye last year ( turned out great could see so much better). IMy opt. Dr. sent me to retina dr. to get shot so he could do surgery because could not see behind eye I quess worried about bleeding. So the Retinq ctr. has continued to do procedures .I thought I wqs going for only one shot. This seems to be on going. They say if don’t do these things could lose sight. I am afraid if keep doing mayy lose sight. what advise would you give on continuing these laser treatments. If I stop both now will make worst. I have been reading lot good results people writing in to you. I do have diabeties can’t get my sugars normal average 300′s. They were much higher. . Take 4 shots a day. Having lot health problems.. I don’t know what to do about about eyes. . Should I not be so afraid of these procedures. Will hurt to have this laser with bruised blood eye. Is it true more blood spots pop up when you haver laser as I was told by friend some doctors don’t do this because more blood spots pop up.

  13. Betty,

    I encourage you to heed the advice of your doctors. The diabetes can cause very complicated issues in your eye. Laser and Avastin are great possible treatments to stabilize your eyes and possibly improve your vision.

    Hang in there. Listen to your docs!

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  14. I am new to this process and frankly a little scared. I had cataract surgery last May. Prior to that had no eye issues other than poor eyesight. Following cataract surgery, my vision was amazing and I functioned well with reading glasses. My first sign of trouble was the arrival of floaters in my left eye. Retina specialist told me I had a bleed and did a laser treatment. A few weeks later, my right eye filled with floaters, almost to the point that I couldn’t see. At first, the RS said it was just floaters and nothing could be done. 6 weeks later, he said it too was a bleed and did a laser treatment. The right eye is much better but now the left eye has lost vision clarity and the RS says I have Macular Edema and need an injection. This progression has taken 6 months. I’m frightened of the injection, or I should say, the fact that I am reading that most people end up with 8 or more injections. I am also seeing that the injections have not been successful much of the time. I am Diabetic but I control it well with oral meds and diet. I am concerned that the disease is going to take my vision whether I go through this process or not. What are the statistics about the number of people thie injections actually help?

  15. I was just diagnosed with POHS. I was administered an Avastin injection in my left eye due to a macular edema that was causing slight distortion in the upper right quadrant. It has only been a few days since my injection, so I have not noticed any visable changes yet.
    In your opinion, is it better to use Avastin or Lucentis in treating POHS?
    I am concerned with the reports of infection from using Avastin. Should I be concerned?
    Are there any lifestyle changes that I can make, or supplements that I can take, to help prevent future problems caused by POHS?
    Is it good to get a second opinion on my diagnosis?

  16. Kristin,

    Second opinions are valuable, but don’t waste too much time. Visual results with POHS, when involving the macula, depend upon the timeliness of treatment. Avastin and Lucentis, in my opinion, usually have the same results.

    Infection from Avastin has been linked to the preparation of the Avastin in compounding pharmacies. Compounding pharmacies must break up the Avastin for use whereas Lucentis is packaged by the manufacturer.

    The drug itself is good.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  17. Kathy,

    Don’t worry about the number of injections, especially if it is working. Multiple injections are often necessary. Results usually take a while. Best to ask your RS about your status from time to time.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

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