Eye surgery

[Dottore]

My 85 year old father is scheduled for some eye surgery described as: "Photodynamic Therapy with Visudyne for Macular Degeneration".

He has shown me a lengthy brochure about this from the eye clinic. There is a laser procedure, but also a shot of this Visudyne stuff involved. After the procedure he is not allowed any exposure to direct light, or light sources over 60 watts for two days. He has to wear gloves and hats and stay indoors in a darkened room for two days. According to the patients guide, the surgery "may or may not be successful" and "a deterioration in eyesight is possible".

My question is, does anyone have any experience with this treatment? Any insights?

I ask, because my father is not sure he wants this or needs it, but it was recommended to him by the eye clinic to which he goes.

[charlesbahn]

This is an (older) treatment for macular degeneration- formation of scar tissue in the back of the eye. The laser activates the chemical (visudyne) injected into the bloodstream to try to stop the formation of the blood vessels that cause the scarring. It was the first surgical treatment for macular degeneration that was shown to be statistically helpful in preserving vision with macular degeneration (high dose vitamins can also be helpful).

This said, the results with "PDT" have not been spectacular, and it is expensive. Most recently a better treatment has become available, the use of Macugen (and other) chemicals that are injected directly into the eye. Sounds horrible, but in skilled hands it doesn't hurt, and has proven much better at treating macular degeneration. It is expensive but it also does work a lot of the time.

Personally. I haven't been terribly impressed with PDT. The most important thing is that your father is being treated by a retina specialist that does a lot of these treatments. If the Macugen-like treatments are an option, they are usually more effective.

There may be special considerations in your father's case that may make PDT a more viable option. I would be comfortable with it if recommended by an experienced retina specialist. I'd be much less comfortable that it is the right way to go if it is recommended by someone who is not.

P.S. I am an ophthalmologist, but not a retina specialist.

Charles

[Dottore]

Charles:

Thanks for this.

The PDT was recommended by my fathers doctor—who is a retina specialist. I had never heard of any treatment like this, and as a lay person it sounded vaguely bizarre.

My father has already had a series of injections directly into the eye. I think this may be the Macugen treatment you described. These appeared to help for a while, but lately the degeneration has continued.

Would you get a second opinion from somewhere before going with the PDT treatment? Or would you just go with the doctors recommendation?

I am particularly concerned about the warnings in the brochure to the effect that the PDT treatment could actually make the condition worse.

[charlesbahn]

A second opinion never hurts and is sometimes reassuring- depends upon the relationship with the treating specialist. If the Macugen hasn't helped, I think it is not very likely the PDT will, but again, I am not the expert here.

I don't think the PDT would really make things worse. The problem with macular degeneration is that it is frequently progressive with any and all treatments and there is a legal liability if patients blame the worsening on the treatment rather than the disease. Hence it is important in counseling patients that they understand the macular degeneration and vision loss may progress with treatment and the vision loss may coincidentally seem worse after a treatment.

Charles