Anti VEGF injections vs laser for retinopathy

[agwagw]

I have proliferative diabetic retinopathy and my consultant has done 6 sessions of laser treatment - it is now beginning to remove my peripheral vision due to the scarring.

He refuses to allow anti VEGF injections as it is "not approved by NICE for this purpose" - though it is allowed for severe diabetic maculopathy and other proliferative vascular eye problems.

A large study in the USA has shown that anti VEGF treatment is much more effective than laser as it allows sight to recover while laser just aims to stabilise at the level when treatment is given.

I have asked him to prescribe 'off-label' but he won't. My question is, has anyone been prescribed anti-VEGF injections for diabetic retinopathy? and if so where are you based? (I am in Wales).

(For info for those new to the term: anti-VEGF is a monoclonal antibody against Vascular Endothelial Growth Factor, it acts by stopping the growth factor that stimulates the damaging blood vessel growth in the eye that causes so many problems)

 

[sally and james]

My question is, has anyone been prescribed anti-VEGF injections for diabetic retinopathy? and if so where are you based? (I am in Wales).

Yes, England, West Midlands, but it was done privately.
Sally

 

[petdell]

I have been having lucentis & eylea injections for the last six years. My Retinopathy has cleared, but my oedema (maculopathy) is not going away.
I would tell your consultant you are worried about future laser scaring. This is my main problem. Correlated retina's from past laser treatments. Looking back there was no alternative 8-10 years ago.
There seem to be very few people on the forum with my problem. I am now at about 100 jabs.

 

[agwagw]

Yes, England, West Midlands, but it was done privately.
Sally

Thanks Sally. Can I ask if it has been effective? Andrew

 

[agwagw]

I have been having lucentis & eylea injections for the last six years. My Retinopathy has cleared, but my oedema (maculopathy) is not going away.
I would tell your consultant you are worried about future laser scaring. This is my main problem. Correlated retina's from past laser treatments. Looking back there was no alternative 8-10 years ago.
There seem to be very few people on the forum with my problem. I am now at about 100 jabs.

Thanks petdell. Good to hear about the success with retinopathy and good luck with the oedema. Can I ask in which part of the country you have had treatment? (just so I can mention this to my consultant). Andrew

 

[petdell]

Sorry meant to say. West midland, again

 

[sally and james]

@agwagw wrote,
↑
Yes, England, West Midlands, but it was done privately.
Sally
Thanks Sally. Can I ask if it has been effective? Andrew

Yes, most definitely. There were no unpleasant after effects or problems and the problem which created the need was solved with only one injection. That was nine months ago, possibly a bit more.
Apologies for not having replied sooner, I hadn't realised that your query was there.
Sally

 

[RobAO]

Hello All, I'm in the midlands too, my consultant is also advising laser which im not keen on. Could i ask which private provider you both use. Thanks in advance Rob.

 

[RobAO]

Yes, England, West Midlands, but it was done privately.
Sally

Sally, could you please message me, i have been advised i need laser but want to go don the anti vegf route and need to know where i could get it done. thanks Rob

 

[RobAO]

Sorry meant to say. West midland, again

Petdel, could you please message me, i have been advised i need laser but want to go don the anti vegf route and need to know where i could get it done. im new so cant private message yet thanks Rob

 

[petdell]

Hi Rob, all the treatments I have had, have been on the NHS. I'm sure ,if your com sultan feels you would benefit from injections, he would prescribe them.
I believe there is a private eye clinic on lode lane solihull. Hope this helps a little.

 

[RobAO]

Hi Rob, all the treatments I have had, have been on the NHS. I'm sure ,if your com sultan feels you would benefit from injections, he would prescribe them.
I believe there is a private eye clinic on lode lane solihull. Hope this helps a little.

Petdel, Thanks for the advice.My consiltants currently recommending Laser but im very concerned re field of vision effects and driving so would like to understand anti vegf alternative too.
Thanks again
Rob.

 

[Dweller]

Let me know how you get on please as I’ve just had my 7th round of laser and still got bleeds happening. Though my peripheral is still good, I’d much rather anti- vegf injections over laser. My doc seemed to be very biase towards laser is the only option, nothing else works.

 

[agwagw]

If its diabetic maculopathy then anti-VEGF is allowed under NICE guidelines, but Drs may resist due to cost (terrible short-termism IMO). If its proliferative diabetic retinopathy then it isn't currently NICE approved, though could be prescribed 'off-label'. I have tried to persuade my consultant to do this but he is very resistant - there is good evidence anti-VEGF is more effective then laser. See: https://journals.lww.com/retinajour...VITREAL_BEVACIZUMAB_FOR_PROLIFERATIVE.14.aspx and see if it persuades your Dr. I have written to Diabetes UK to lobby NICE on this - the more who contact Diabetes UK the better ps a moment ago I gave a 2014 early study link, the one I've replaced it with is the 2017 study I meant to put in.

 

[Dweller]

See. That looks so darn better than having them burn away all the side vision. Surely this should be the better treatment for all of us. Sod the cost. :<
I’ve got an appointment on Monday so will hopefully show them this link and try to persuade off label use or to be a trial in clinic to see how well it works.. They’ll probably just keep saying no but no harm in trying. My aches have been through a lot these past six months. So achey.

 

[Montreal]

I can tell you that nearly four years ago, after nearly 25 years of Type 1, Diabetes, and knowing for over two years that I had had background retinopathy, macular edema (DME) hit me on my right eye. This was out of the blue, with my vision acuity dropping to 60%.
Due to the location of the leakage, close to the fovea, laser was ruled out.
That left only Anti-VEGF as a viable option.
One thing I have to say - they worked, thanks God. My vision was restored over the next four months to 100%. It is still so.
The caveat - Anti-VEGF injections (Eylea) are no permanent solution. In case of persistent DME, they will be required again. Since 2014, I had on average 3-5 injections per year, with only 2016 being "injection free". Pleasant it is not, but hey, for maintaining good vision I'd be more than happy to go through this every morning.

 

[bellapodus]

Interesting reading people's opinions. I am having an opposite feeling towards anti-VEGF.
I had one round of lasers in my right eye which did the trick in 2016. However, I moved to Spain shortly afterwards.
I have had 2 rounds of anti-VEGF in both eyes with disastrous affects in my left eye.
Both times were excruciating with the injection and with blood in my eye (lasted up to 10 days after) plus felt like someone had punched me for a week after. I am now left with a permanent feeling of a dull headache on my left eye and I refuse to go for my 3rd injection next week. I have no improvement and have felt unwell ever since (occasional dizziness and difficulty with sleeping). No one listened to me about the pain when I had the 2nd injection and was told it was in my mind.
Has anyone else had a reaction to the injection?

 

[FantomPoet]

My first injection I was so so tense and it felt bruised as the doctor had to pin my eye down with her finger so she could inject safely. My second Eylea injection felt like I had been shot in the eye with bleeding making it go totally red for a few days (THe white not the vision). I have had 8 now and all the others have happened without any issue. I think as I got used to the idea I have relaxed and not twitched or reacted as they have done it. In fact now my Boss kind looks at my eye strangely when I roll back into work as if he is wondering if I just slept in

 

[runningwitht1]

I’m going to be having an avastin injection before my vitrectomy for PDR and was talking to the vitreal-retinal surgeon about anti vegf injections for Proliferative retinopathy as he has just been involved in a trial. I got the impression that avastin and eylea May become more available soon on the nhs?

He did say however that the anti vegf injections do not stabilise retinopathy and are only temporary so patients may need 3 injections per year. Only laser can actually stabilise the condition, but with the potential damage to peripheral vision etc that anti vegf injections apparently avoid.

 

[KJKing]

I too today have been advised that within the next year I will need laser treatment or vegf injections even a combination apparently. I was just wondering it may sound like a silly question but I honestly don’t know, I wear glasses currently, does laser treatment fix the vision problems or do you continue to wear glasses after the procedure. It’s an odd question I know but I was just generally interested to what happened with this after a laser procedure