EyeWorld Asia-Pacific December 2015 Issue

Retina: A cataract surgeon’s guide to anti-VEGFs December 2015 37 EWAP SECONDARY FEATURE of anti-VEGF therapies, but according to Dr. Holekamp, referral to a retina specialist is the standard of care for most geographic locations. Ophthalmic surgeons spend years honing their skills in a particular subspecialty to be able to deliver the best care to their patients. But subspecialties change rapidly and require an enormous amount of effort to stay up to date with current treatment paradigms. Providing the best care for retina patients requires knowing the subspecialty as well as any retina specialist, Dr. Dugel said, something that is nearly impossible to do. “It’s hard enough to keep up with one subspecialty; to be able to keep up with another one plus yours is an exceptionally difficult thing to do,” he said. Retina in particular has been a fluid and dynamic field in recent years, and even dedicated specialists don’t always get it right. Until recently, most specialists thought that injecting patients every 4 weeks would deliver the best outcomes, Dr. Dugel said. Recent research has shown, however, that treating every 4 weeks is not only an unmanageable treatment burden, but may or may not be associated with macular atrophy, fibrosis, and loss of vision in the long run. In light of this research, retina specialists have shifted to giving each patient a more individual, customized treatment. “There’s no cookie-cutter recipe for patients with macular degeneration or diabetic macular edema or vein occlusion,” Dr. Dugel said. “All of these treatments need to be customized. If you customize and individualize the treatments, you can not only decrease treatment burden, you can get as good if not better outcomes.” But to be able to customize treatment requires knowledge that only comes with experience. “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 continued. “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 specialists give injections only if they have a special interest in retina and have dedicated themselves to understanding the patients, the disease, the patterns of treatment, and the relevant issues, such as progressive geographic atrophy in AMD. If you’re considering giving injections—especially if you’re looking for an additional revenue stream—consider that it carries a responsibility that extends far beyond the actual injection. “It’s not a moral, ethical responsibility, it actually is a legal responsibility 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 becomes— is that another legal liability you want to take?” EWAP OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 • Fax +852 2987 1090 www.oculus.de • info@oculus.hk 欧 洲 科 学 之 路 See all the relevant dry eye information at a glance! OCULUS Keratograph 5M Now you can summarize all data from your dry eye work up in one report! The new JENVIS Dry Eye Report is a one page overview that displays the results of dry eye exams with the Keratograph 5M, such as Meibography, NIKBUT, TMH and Bulbar Redness. Additionally, you can enter the data you have collected from other tests, such as Osmolarity, Blink Rate, OSDI Dry Eye Questionnaire and more. NEW JENVIS Dry Eye Report Editors’ note: Drs. Dugel and Holekamp have no financial interests related to this article. Contact information Dugel: pdugel@gmail.com Holekamp: nholekamp@gmail.com