Monthly Archives: August 2013

Confusion between PreserVision AREDS-2 and “New” PreserVision AREDS-2

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There is confusion between PreserVision AREDS-2 and “new” PreserVision AREDS-2.   In September 2013 Bausch and Lomb changed the contents of PreserVision AREDS-2 and renamed the new vitamin, “New” PreserVision AREDS-2. The color of the box and the label on the bottle remain the same. The difference between the old and new vitamins is the “new” formulation lacks omega-3 fatty acids. They were removed because the AREDS study group was unable to demonstrate a benefit in patients with age-related macular degeneration (AMD). Other smaller studies have suggested a benefit and additional studies are needed to confirm or refute the value of omega-3 fatty acids in AMD.

Why is the difference important to me?

The importance in the difference for patients lies with the dosage. The recommended dosage for the older PreserVision AREDS-2 was two softgels twice a day. The recommended dosage for the “New” PreserVision AREDS-2 is one softgel twice a day. To avoid an error in dosing, patients need to be aware of which of the two similar vitamins they are taking.

Is there a cheaper version of AREDS-2 vitamins?

Yes.  As the patent expired on the ARED-2 formula, there are less expensive options now available.  The least expensive AREDS-2 vitamin that I am aware of at the time I write this blog is Equate Advanced Eye Health Complex by Walmart.  This vitamin is equivalent to the “New” PreserVision AREDS-2, but much less expensive. It is taken one pill twice-a-day.

By Scott E. Pautler, MD

 

PreserVision AREDS 2
PreserVision AREDS 2 (click to enlarge)
New PreserVision AREDS2
New PreserVision AREDS 2 (click to enlarge)

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.

Copyright  © 2023 Designs Unlimited of Florida.  All Rights Reserved.

Sub-Tenon’s Steroid Injection

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Why is a sub-Tenon’s steroid injection performed?

A sub-Tenon’s steroid injection (STS) is an office procedure performed to decrease inflammation, swelling, or leaky blood vessels inside the eye. The steroid medicine acts to decrease inflammation and leakage from blood vessels from a variety of causes, thereby offering the opportunity for improvement in vision. The effect of STS lasts for several months after which repeated injection may be considered if necessary.

How is a sub-Tenon’s steroid injection performed?

Anesthetic solutions are used to make the procedure pain-free. A pressure sensation is often felt as the steroid is injected next to the eye with a very thin, short needle. The procedure is brief.

Periocular steroid injeciton
Sub-Tenon’s Steroid Injection (click on image to enlarge)

Will the injection affect my vision?

The vision may be slightly blurred immediately after an injection. The anticipated improvement in vision occurs slowly over a period of weeks to months. Sometimes, the pressure inside the eye increases and may require eye drops for several months. There may also be an increased rate of cataract formation. It is common for the upper lid to droop slightly; this improves over several months.  Rare risks of steroid injection include bleeding, infection, retinal detachment, glaucoma, and loss of vision. Please report any severe loss of vision to the doctor without delay.

How do I care for the eye after injection?

If a patch is placed on the eye, keep it on as directed by the doctor, usually 2-3 hours. You may be given eye drops and instructions on how to use them. Physical activity is not limited after STS. Tylenol or Ibuprofen may be used if there is discomfort after the injection, but severe pain should be reported to your doctor without delay. It is normal to experience a red area on the white of the eye, which disappears in one to two weeks. If you have any questions or concerns, please call the office.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.

Copyright  © 2013-2022 Designs Unlimited of Florida.  All Rights Reserved.

Lucentis (ranibizumab) Therapy

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vial of Lucentis
Lucentis vial

 

What is Lucentis therapy?

Lucentis therapy is a treatment for wet-type macular degeneration, diabetic retinopathy, myopic macular degeneration, and retinal vein occlusion.  It involves painless injections of medication into the eye to stop abnormal, leaky blood vessels. It is also used in the treatment of other retinal disorders.

How effective is Lucentis therapy?

Lucentis was proven in extensive studies to be very effective. In wet-type macular degeneration, a large study showed that monthly injections of Lucentis over a two-year period offered a 90% chance of stable or improved vision. Similar benefits are seen in other retinal conditions as well. Currently, therapy often starts with monthly injections until maximal vision is restored. Afterwards, the injections may be given less frequently to maintain stable vision. In some cases, the medication may be stopped and the eye kept under careful observation for reactivation. There are several medications in this class; the best choice of medications depends on the underlying diagnosis.

What are the risks of Lucentis therapy?

Severe complications are very rare, but risks of Lucentis injection include bleeding, infection, glaucoma, retinal detachment, cataract, and loss of vision/loss of the eye. The risk of retinal detachment is about 1 in 5,000 injections, but the results of surgical repair are poor.  There may be an increased risk of difficultly with future cataract surgery estimated to be about 1% of cases. In these cases the fibers (zonules) that hold the cataract in place may become weakened from Lucentis injection. When this occurs, special techniques are required to remove the cataract and place a lens implant. Rarely, two procedures are required to accomplish the task. Studies are ongoing to determine if there may be an increased risk of stroke with AMD therapy. Currently, it appears that Lucentis places a patient at lower risk of stroke and heart attack compared with the other medications used to treat macular degeneration and diabetic retinopathy.(Reibaldi 2022)  Pregnancy should be avoided while on Lucentis therapy.

intra-ocular injection
Intra-vitreal injection

What do I expect after a Lucentis injection?

Be careful not to rub the eye after the injection because the eye may remain anesthetized for several hours. You may be given eye drops and instructions on how to use them. Physical activity is not limited after the injection. Tylenol or Ibuprofen may be used if there is discomfort after the injection, but severe pain should be reported to your doctor without delay. It is normal to experience a red area on the white of the eye, which disappears in one to two weeks. If you have any questions or concerns, please call the office.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.

Copyright  © 2013-2022 Designs Unlimited of Florida.  All Rights Reserved.