1. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  2. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2021 »
    Dismiss Notice
  3. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
  4. Guest, stay home, stay safe, save the NHS. Stay up to date with information about keeping yourself and people around you safe here and GOV.UK: Coronavirus (COVID-19). Think you have symptoms? NHS 111 service is available here.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

Anti VEGF injections vs laser for retinopathy

Discussion in 'Diabetic Retinopathy' started by agwagw, Nov 28, 2017.

  1. Dark Horse

    Dark Horse · Well-Known Member

    Messages:
    1,627
    Likes Received:
    900
    Trophy Points:
    133
    The laser treatment for diabetic retinopathy targets the retina at the back of the eye and does not fix the vision problems which are normally corrected by glasses. There is a type of laser treatment (LASIK) which is used to try and remove the need for glasses but this targets the cornea at the front of the eye.
     
  2. agwagw

    agwagw LADA · Well-Known Member

    Messages:
    75
    Likes Received:
    33
    Trophy Points:
    58
    I concur with Dark Horse, laser to correct vision (instead of glasses) adjusts the shape of the cornea by cutting parts of it away. Laser for retinal treatment doesn't affect the cornea or lens (the wavelengths of the two lasers is different, one heats the cornea, while the other passes straight through to the retina where it couples and heats the target).

    Not been on this thread for a while, interesting to see the posts. I have been receiving Eylea injections in one eye since the autumn, with significant improvements. Some items for interest:

    The injections are usually done by the "Nurse Injector" who is very experienced. She uses retractors to keep the eyelids open and she marks the injection point on the surface of the eye so as to avoid blood vessels. While the injections are a bit painful, there has only been a small amount of bleeding if any.

    However, one day the nurse was ill so the Dr on duty had to take the list. When my turn came he did not use retractors and was trying to hold the eyelids open with one hand and inject with the other. He hit a blood vessel and I had a sub-conjunctival bleed so my eye was bright red for about 10 days (didn't affect the vision thankfully).

    The anti-VEGF injections will now always be needed as it works by neutralising the growth factors that cause the unwanted blood vessels to grow, new unwanted growth factors will still be produced. There is also evidence that some new blood vessels can reduce with the anti-VEGF, so there is an actual improvement, something laser can never do - it just attempts to stop already problematic vessels from developing further, but damages the retina in the process. In my right eye that had the pan-retinal laser treatment my peripheral vision, especially at night, is poor. In my experience, the laser treatment is much more painful then the injections.

    Eyelea is more expensive then the others, but it is only needed every two months (once improvements are seen) which comes out to about the same price but with half the number of injections.
     
  3. BibaBee

    BibaBee Family member · Well-Known Member

    Messages:
    582
    Likes Received:
    1,391
    Trophy Points:
    178
    Thanks for sharing! I know a lot of people of scared about the injections, so it is really helpful to share your (mostly) positive experience. I'm thankful my husband is receiving his treatment on the NHS (actually, the first one was done privately). He's needed monthly injections since July last year.....they are only just starting to increase the gaps between treatment now. We're due at the eye hospital thus Friday, which is good, as he feels his vision has tailed off again. It's only been just over 5 weeks since his last. Do you find you notice the effects wearing after a few weeks or so @agwagw ?
     
    • Hug Hug x 1
  4. agwagw

    agwagw LADA · Well-Known Member

    Messages:
    75
    Likes Received:
    33
    Trophy Points:
    58
    Hi BibaBee, Is your husband having Eyelea or one of the others? My experience was that there wasn't much improvement until the third injection. After that, there was noticeable improvement most months, though it did drop back once or twice. Once it seemed stable the time period was moved to six weeks and now eight weeks - but they didn't increase the time until stable. Hope it all goes well.
     
    • Friendly Friendly x 1
  5. BibaBee

    BibaBee Family member · Well-Known Member

    Messages:
    582
    Likes Received:
    1,391
    Trophy Points:
    178
    I'm afraid things aren't so good. He's woken up this morning with a massive bend in his only good eye (he has impaired vision in his other due to unrelated corneal scarring, as well as the oedema). He has been noticing his vision get progressively worse over the past 10 days or so. He has severe anxiety and is in a state of panic right now. We've moved forward the injections to tomorrow and hopefully they will do the trick again. I have a feeling he has a chronic case of DMO and will need monthly treatment for a lot longer yet. It can't be a coincidence that this happened when they moved from 4 to 5 week intervals (actually 5 weeks and 2 days to be precise).
     
    • Hug Hug x 2
  6. agwagw

    agwagw LADA · Well-Known Member

    Messages:
    75
    Likes Received:
    33
    Trophy Points:
    58
    So sorry to hear that, fingers crossed for tomorrow.
     
    • Friendly Friendly x 1
  7. BibaBee

    BibaBee Family member · Well-Known Member

    Messages:
    582
    Likes Received:
    1,391
    Trophy Points:
    178
    @agwagw Just to give an update, my OH had his injections on Thursday last week, so just coming up to a week. His vision isn't back to where it was a few weeks ago, but steadily improving. He feels a lot better and less anxious. The verdict is that they will need to stick with 4 weekly injections for now, which is what I suspected.
     
    • Hug Hug x 1
  8. agwagw

    agwagw LADA · Well-Known Member

    Messages:
    75
    Likes Received:
    33
    Trophy Points:
    58
    Glad to hear of the improvement, hope it continues well. Just for interest, is it Eyelea?
     
  9. BibaBee

    BibaBee Family member · Well-Known Member

    Messages:
    582
    Likes Received:
    1,391
    Trophy Points:
    178
    Yes, it is.
     
  10. SWalsh

    SWalsh · Newbie

    Messages:
    1
    Likes Received:
    0
    Trophy Points:
    1
    Hi Montreal, interested in your symptom at diagnosis - I have a small degradation in vision (can read the eye test chart one level lower than the affected eye) so went for Oct scan and they have said it’s maculopathy but she doesn’t think it needs treatment yet. Mine is also central so laser not possible - was your 60% vision acuity instant or gradual and did you have treatment immediately? My scan was not good enough for the ophthalmologist to see exactly what is going on. Ur having another tomorrow, feeling frightened :( Many thanks
     
    • Hug Hug x 1
  11. Koalajane

    Koalajane Type 2 · Well-Known Member

    Messages:
    62
    Likes Received:
    39
    Trophy Points:
    38
    About 5 months ago I went to the eye clinic and was told my left eye had macular oedema and I would need injections. I already have it in my right eye which has improved with the injections. I got home to a message on my phone to say that the left eye did not meet the criteria for injection so it would be laser. After many phone calls I got an appointment for July 1st and injection appointment for my right eye on July 2nd. A week before the laser the appointment was cancelled by the clinic. At my injection appointment I was told the left eye now met the criteria for injection so had them both injected that day.
    Not sure what the criteria is but wonder if it is anything to do with finances.
    I knew my eye had got worse but whenever I rang to chase the laser appointment I was told it was down as a regular appointment and not an urgent one. I then got an appointment for laser on July 19th which after the Consultants secretary discussed it with the consultant was cancelled as I didn’t need it as having injections. I do despair.
     
  12. agwagw

    agwagw LADA · Well-Known Member

    Messages:
    75
    Likes Received:
    33
    Trophy Points:
    58
    Hi Koalajane,
    The criteria will probably the the thickness of the macula, which increases as the oedema progresses. It is 400um on the OCT scan before injections are allowed by NICE. My previous consultant refused injections as my macula was 380um - my central vision at that point was rubbish. I tried to argue that with the machine error I was likely to be over the magic number - talking to brick wall - he was a laser chap and would not change his view. Fortunately my new consultant was better informed or sympathetic to the argument as I went on Eyelea injection last October. Vision has improved considerably as a result.

    Glad you got the result you wanted - good luck with the treatment!
     
  13. Sjayh

    Sjayh · Member

    Messages:
    7
    Likes Received:
    1
    Trophy Points:
    1
    Hii.
    I actually had both done! My vision is the best is has been in years. I was told I was partially sighted and registered too.
    Feel free to read it on my blog... araneljay.com drop a message if you need
     
  14. sedrah

    sedrah · Member

    Messages:
    7
    Likes Received:
    0
    Trophy Points:
    21
    HI all
    also, I have been advised that I need anti VEGF injections.
    could you give me your experience and your advice, please
     
  15. agwagw

    agwagw LADA · Well-Known Member

    Messages:
    75
    Likes Received:
    33
    Trophy Points:
    58
    Hi Sedrah,

    I had Eyelea injections in one eye for a year or so and it made a huge difference. Eyelea is more expensive then the common alternative, but the injections are less frequent and it is more effective according to published research.

    The process is that you will have an eye test, dilating drops and probably an OCT scan and check by a consultant - a cross will be written on you forehead to show which eye is to be treated. A nurse will then give you pain killer drops and iodine antiseptic drops. You will then be sat in a reclining chair and a Dr or a nurse practioner will put a clip to hold your eyelids open, then more drops in and ask you to look to one side as they inject through the white of the eye. It is uncomfortable but less so than fitting the clip. The liquid that goes into the vitreous humour is visible for a while until it disperses into the vitreous - it looks a bit like a lava lamp, blobs moving around. Only takes an hour or so to vanish. My advice is to relax as much as possible and look at something to keep your eye completely still.

    In my experience, our 'Nurse Injector' was fantastic - she was doing the procedure day in and day out. She took care to avoid small capillaries in the white of the eye. My one injection by the Dr led to a 'red eye' as there was a tiny bleed below the conjunctiva, it cleared up in a few days.

    Out of interest, are you having the injections for macula swelling or proliferative retinopathy?
     
  16. sedrah

    sedrah · Member

    Messages:
    7
    Likes Received:
    0
    Trophy Points:
    21
    Hello
    thank you for the information.
    Am getting injection for macula swelling for both of my eyes.
    I have a question how many injections did you get in total and how long did it take to see difference in your vision .
    And what is the difference between macular swelling and proliferative retinopathy?
     
  17. agwagw

    agwagw LADA · Well-Known Member

    Messages:
    75
    Likes Received:
    33
    Trophy Points:
    58
    Hi Sedrah,

    I had about 8 injections in total and I saw improvements after about four.

    Macula swelling is when the central vision area gets blurred and retinopathy is when blood vessels proliferate over the retina and can burst or cause other problems. Eylea can help both conditions but is currently only 'licensed' in UK for macula issues.
     
    • Like Like x 1
  18. Koalajane

    Koalajane Type 2 · Well-Known Member

    Messages:
    62
    Likes Received:
    39
    Trophy Points:
    38
    I have had laser recommended again as my consultant says it is more permanent and I shouldn’t need injections as often. Any thoughts and how does it compare to injections pain wise. I had injections this morning with no problems. My consultant has ordered a dye test first to see if it is suitable for me. Thanks
     
  19. agwagw

    agwagw LADA · Well-Known Member

    Messages:
    75
    Likes Received:
    33
    Trophy Points:
    58
    Laser can only stop blood vessels where it hits, it cannot reverse problematic blood vessels. Eyelea stops new blood vessel growth but can also reverse some of the damage. There was a large study in the USA a few years ago that shows that Eyelea is more effective against proliferative diabetic retinopathy than laser.

    A few laser burns aren't too bad but if they do a pan-retinal treatment (large numbers of burns) it is painful.

    The dye treatment I guess is fluorescein angiography, which will show info about blood vessels just below the surface of the retina. It turns you bright yellow and your pee is amazing (fluorescent) for a few hours!
     
  20. Dark Horse

    Dark Horse · Well-Known Member

    Messages:
    1,627
    Likes Received:
    900
    Trophy Points:
    133
    Not quite true. Laser destroys areas of retina that are not receiving an adequate blood supply so are producing VEG-F (vascular endothelial growth factor). Once the production of VEG-F drops, no new vessels form but also existing vessels tend to regress. Some discussion here:- https://www.healio.com/news/ophthal...thy-receive-panretinal-laser-photocoagulation

    There is a short discussion of anti-VEG-F injections and/or PRP here:- https://www.eurotimes.org/anti-vegf-vs-prp-which-is-best/
     
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook