By Kamal Kishore, MD, Retina Specialist, Illinois Retina & Eye Associates
Most of us assume that if we’re not seeing well, we need new glasses. We’ll go to an eye doctor expecting new glasses to correct the problem, or at the most, be instructed to use eye drops for a while. The news that ongoing injections of medicine directly into the eye might be needed comes as a huge shock producing reactions of disbelief, shock, anxiety, and fear. Our practice has administered more than 18,000 injections over the last six years and has developed a comprehensive approach to educate the patient and their family members regarding the benefits of the injections, alternatives, follow-up care, and strategy to make the process as painless as possible.
Who came up with this idea?
Approximately 40 years ago, my future teacher and Hall of Famer eye doctor, Dr. Peyman, discovered that most antibiotics never reached levels high enough to be effective inside the eye after oral medication or IV injections. He proposed antibiotic injections directly into the eye to treat cases of infection inside the eye, a condition known as endophthalmitis. He was extremely criticized by the leading experts at the time, but his idea was soon widely accepted and a vast majority of endophthalmitis cases are now currently treated with intraocular injections.
About 15 years ago, the use of steroid injections began for some cases of swelling and inflammation inside the eye in a manner similar to steroid shots for arthritis and back pain. In the past decade, we have seen the extensive use of protein molecules to treat several eye conditions affecting the back of the eye. These proteins cannot be given by mouth because our intestines would digest them. IV injections expose the entire body to the protein and can have serious side effects in other parts of the body. Therefore, the only practical method is to inject these medications directly into the eye by an intraocular injection.
What common conditions use injections?
Presently, injections are the most effective treatment for “wet” macular degeneration, swelling inside the eye from diabetes, and vein blockages. Some other conditions of infection and inflammation are also routinely treated with injections.
How often and how long?
Most patients with macular degeneration, diabetes, and vein blockages require long-term treatment because the medication loses its effect after 1-2 months. Although a patient may experience better vision after the first injection, the benefit is not going to last very long without further injections. Although the need for injections becomes less frequent with time, some patients require injections for years.
Will I need injections?
A complete eye exam is done at each visit to look for a drop in vision and an increase in swelling or bleeding in the back of the eye. The latest generation of scanners can detect even the smallest swelling of the macula (most sensitive part in the back of the eye) using laser technology. The goal is to detect swelling before it affects vision. Most patients need injections as long as there is swelling in the macula.
Will it hurt?
We are very sensitive to the issue of patient comfort, and take all precautions to make the procedure as painless as possible. Each individual patient is unique regarding anesthetic requirements for the procedure and receives a tailored numbing technique individualized for them. Patients who have transferred care to our practice from other doctors have regularly commented how comfortable they were in our practice and how painless the overall experience was.
If you have questions regarding the health and care of your eyes, attend a free presentation “I’m Getting Older, Why Can’t I See So Good Anymore?” on Nov. 11 or 17 from 5–6:30 p.m. on cataracts and macular degeneration. FREE eye disease scans and a video of LIVE cataract surgery will be shown. Refreshments will be served. Please register by calling Illinois Retina & Eye Associates at 309-589-1880.
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