65
EW RETINA
October 2015
Contact information
Boyer: vitdoc@aol.com
Charles: scharles@att.net
the injection process. "I think it's
essential because when you draw up
the drug in a syringe and adjust it,
you hold it right up by your face,"
he said. "Then you're breathing on
the needle."
Managing these patients also
means looking at the OCT yourself.
"You need to use spectral domain
OCT, not time-domain OCT," Dr.
Charles said, adding that it's also
important to use black and white,
not the color images and to be sure
to look at each of the slices yourself
and not leave this to the technician.
It ultimately comes down to a
question of excellence and doing the
best by the patient, he said. "I beat
up on my vitreoretinal colleagues
who dabble in phaco," he said,
adding that the same holds true for
those cataract surgeons who may
not know all they need to about
anti-VEGF injections.
Coordinating with cataract
When it comes to coordinating
the use of anti-VEGFs with cataract
surgery, there is a fair amount of
flexibility. If a patient is on a 5-week
schedule for one of the anti-VEGFs
for wet AMD or vein occlusion and
has cataract surgery scheduled on
Tuesday, it is perfectly fine for him
or her to be injected on Monday, Dr.
Charles said. However, if the patient
underwent cataract surgery on
Monday and is due for an injection
on Tuesday, it may be best to delay
a week or so to ensure that the cata-
ract wounds are more watertight.
Dr. Boyer agreed that these can
be done in close conjunction. He
sometimes advises cataract surgeons
to put a suture in to temporarily
reinforce the wound so that there is
no leak with any increased pressure.
"I encourage them to put one suture
in, which can be removed later once
the wound is healed," Dr. Boyer said.
For the future, he hopes to
have longer-acting anti-VEGF drugs.
"For almost every condition that is
treatable—macular degeneration,
diabetes, and vascular occlusions—
I think it's important to identify
the patients early and get them in
the hands of the retina specialists,"
he said. "These are vision-altering
drugs that can really help our
patients." EW
Editors' note: Dr. Boyer has financial
interests with Regeneron, Genentech,
and Novartis (Basel, Switzerland).
Dr. Charles has financial interests
with Alcon (Fort Worth, Texas).
