Eyeworld

85 EW SECONDARY FEATURE October 2015 "AMD is not the same disease in everyone," Dr. Holekamp said. "I have patients who will require a monthly shot until the day they die. And I have patients who get 3 injections and never need another one. But the majority of patients are somewhere in the middle, and that's what the art of medicine is—not overtreating and not undertreating. "I don't think you can learn it in a fly-by-night way," she contin- ued. "You have to dedicate your time and your practice to seeing hundreds of these patients and learning how they respond to these therapies." Pearls of wisdom There are undoubtedly some situations when cataract surgeons or general ophthalmologists will need to treat retina patients. The two specialists agreed that when you can, it's best to refer, but if you can't, dedicate time to learning as much about the underlying disease as possible. "We have really smart, talented people in our profession, but you can only be an expert in so many things," Dr. Holekamp said. She recommended that non-retina spe- cialists give injections only if they have a special interest in retina and have dedicated themselves to under- standing the patients, the disease, the patterns of treatment, and the relevant issues, such as progressive geographic atrophy in AMD. If you're considering giving in- jections—especially if you're looking for an additional revenue stream— consider that it carries a responsibili- ty that extends far beyond the actual injection. "It's not a moral, ethical respon- sibility, it actually is a legal responsi- bility because should complications occur, that person will be held to the same legal standards as someone who's a retinal specialist," Dr. Dugel said. "And then the question be- comes: Is that another legal liability you want to take?" EW Editors' note: Drs. Dugel and Holekamp have no financial interests related to this article. Contact information Dugel: pdugel@gmail.com Holekamp: nholekamp@gmail.com Beaver-Visitec International, Inc. | 411 Waverley Oaks Road Waltham, MA 02452 USA BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of a Beaver-Visitec International ("BVI") company © 2015 BVI * Bloomenstein, Marc. "Punctal Occlusion May Improve Visual Acuity for Contact Lens Patients," Optometry Times, July 2014. EXTEND™ Beaver-Visitec, the world leader for punctal occlusion implants, is proud to offer EXTEND™ Absorbable Synthetic Implants which are intended for 90 day treatment of dry eye. EXTEND can: • Help prevent dry eye following ocular surgery • Enhance the retention of ocular medication • Help prevent contact lens dropout* • Provide comfort for seasonal dry eye and climate changes TO ORDER: 866-906-8080 customersupport@beaver-visitec.com or beaver-visitec.com EXTEND Comfort for Dry Eye Patients One Step at a Time Learn more at AAO booth #1221. Should cataract continued from page 84 by EyeWorld staff Intravitreal injections to treat retinal disease ASCRS members weigh in A nti-VEGF agents are not just for age-related macular edema (AMD) anymore. They are also currently being used to treat diabetic macular edema (DME) and retinal vein occlusion (RVO). They have been found to effectively treat these conditions, but they do have one minor downside: Because they are injected intravitreally, typically on a regular basis, patients must commit to visiting the oph- thalmologist regularly. In the 2015 ASCRS Clinical Survey, ASCRS members were sur- veyed about their use of intravitreal injections for patients with retinal disease. When asked whether they per- sonally perform intravitreal injec- tions for their patients with retinal disease, 30% of all respondents said yes. However, 45% of non-U.S. sur- geons said that they perform them, while only 18% of U.S. ophthalmol- ogists said that they perform them, making non-U.S. doctors two and a half times more likely to perform ASCRS Clinical Survey intravitreal injections than U.S. doctors. Physicians were also asked about the percentage of patients with reti- nal disease in whom they personally perform the injections. On average, physicians said that 49% of their continued on page 86

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