EyeWorld Asia-Pacific December 2015 Issue

Retina: A cataract surgeon’s guide to anti-VEGFs December 2015 36 EWAP SECONDARY FEATURE Should cataract surgeons give anti-VEGF injections? by Lauren Lipuma EyeWorld Staff Writer Data from the 2015 ASCRS Clinical Survey showed that roughly 18% of U.S. cataract surgeons and 45% of non-U.S. cataract surgeons perform intravitreal injections. The majority of respondents believe they have an in-depth understanding of these therapies. Source: ASCRS What is the standard of care for treating retinal disease? A ny competent ophthalmologist is capable of giving anti-VEGF injections to treat retinal disease. And in certain situations, it might make sense for a cataract surgeon or general ophthalmologist to do that—such as in rural areas where a specialist is not available. According to the 2015 ASCRS Clinical Survey, 18% of U.S. cataract surgeons are giving injections—but is this in the best interest of the physician and the patient? According to two prominent retina specialists, referring the patient to a retina specialist— even for simple injections—is the standard of care. The question isn’t whether most ophthalmologists are capable of giving injections, they said. The question is: Do they have a deep enough understanding of the underlying disease to appropriately manage these patients? And do they have enough time to allocate to learning the nuances of treating retinal disease? The tip of the iceberg Performing an intravitreal injection is straightforward, but treating patients with retinal disease requires knowing more than just how to give an injection. “Can people give injections? Sure, they can give injections,” said Nancy Holekamp, MD , professor of clinical ophthalmology and visual sciences, Washington University School of Medicine, St. Louis. “Should they be giving injections? That’s a different question because for standard of care, state-of-the-art medicine, the giving of injections requires an in-depth understanding of these diseases and how they respond to these injections.” “Once you inject, you assume the responsibility of having evaluated the patient, knowing the latest literature, knowing the treatment strategy, and managing the patient,” said Pravin Dugel, MD , managing partner, Retinal Consultants of Arizona, Phoenix, and clinical professor, University of Southern California Eye Institute, Keck School of Medicine, Los Angeles. “Not only the complications that could potentially occur, but managing the patient when that’s going on.” Giving anti-VEGF injections is just the tip of the iceberg when it comes to treating retinal disease, Dr. Dugel said, just as giving a patient glaucoma drops or doing filtering surgery is just the beginning of glaucoma care. “I can do glaucoma surgery, but I don’t pretend to know as much about glaucoma as a glaucoma specialist,” Dr. Dugel said. “It’s not the act of doing glaucoma surgery, it’s the act of managing the before, the during, and the after and being completely up to date with the changing technology.” According to the ASCRS Clinical Survey, the majority of cataract surgeons believe they have an in-depth understanding of anti- VEGF therapies, but that does not mean that they fully understand the underlying diseases and how to manage them, Dr. Holekamp said. “Giving the injection isn’t the difficult part,” she said. “The difficult part is knowing how and when and managing these patients.” What is the standard of care? It’s helpful that cataract surgeons have a working knowledge