Ken
People have been whispering the S word, steroids
Yes - and it reached Yahoo about a week ago ....
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Below is a message I received from a highly trained experienced ophthamologist friend of mine whom I consulted as part of my initial research into PSDV.
Hope this generates some meaningful discussion. I myself am a physician but have limited ophthamology background. I understand the disease of DME and have a rudimentary understanding of the tx options.
" For the past 5-7 years, intravitreal triamcinolone(IVT) became incredibly popular for diabetic macular edema (DME). This prompted a large prospective trial to compare the old standard of treatment, (focal laser) with IVT. The long term study results revealed that the overall outcomes were actually better with focal laser. In addition, there were not insignificant complications associated with IVT including infection, cataract and glaucoma. So, there has been a paradigm shift away from steroids and the new area of interest has become the VEGF inhibitors for improving visual acuity in DME. Those results are still pending.
In my opinion the injectible implants as below may have a limited role but will likely not supplant focal laser with or without VEGF inhibitors as the majority of treatments for DME."
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messages.finance.yahoo.com
Enuf to shake my timbers ......
Hmmmm .....
Jan/Feb 2009
... 2004 data
patients with
diabetes and DME
compared with patients with diabetes alone,
the difference was
$28,606 vs $16,363.
retinatoday.com
so the difference of $12,243 is what the DME Eye guy gets
and if I use an 8% increase in cost (just made it up)
then the DME Eye guys gets about $16,700 in 2008.
If I multiply it times 2 (IIuvien last 2 years) its $33,400 per patient = (maybe) financial incentive?
Unfortunately the data presented did not break out the
cost between focal and grid laser treatments so I assume
the $12,243 is some average.
Sidebar (2004 data)
-------------------
Rein and colleagues estimated that the total direct medical
cost of diabetic retinopathy among adult Americans
for 2004 was $493 million.10
On the same Yahoo thread this popped up .....
I am a semi-retired pharmacist filling in at a pharmacy in the Johns Hopkins out patient pharmacy in the complex housing the Wilmer Eye Clinic. Suffering from macular degeneration from both diabetes and being in my senior years. I have been receiving injections of AVASTIN (which basicly is a drug for cancer being used off lable to treat my problem. I am close to the retinologists who practice at the clinc. They are optimistic about what they have read about the progress of PSDV. GLTL
messages.finance.yahoo.com
The IVT vs LASER is a no contest - Laser wins 5 to 0.
Nevertheless - somebody is using it right now?
Why?
While laser photocoagulation is effective in halting the
progression of focal DME, it is less effective in patients
with diffuse DME, a generalized breakdown of the bloodretinal
barrier. Randomized studies have shown that laser
photocoagulation reduces visual loss due to DME, but
despite laser treatment 15% of patients still lose
vision.11,1
You will chuckle (I think) at my source ....
retinatoday.com
Then there is this ... (hates steriods too)
"Physicians today have few treatment options for DME patients," Dr. Paggiarino said. "There remains a clear need to provide additional options — especially ones that provide significant visual benefit while also avoiding treatment-related ocular side effects, such as the inherent retinal ablation from laser, or IOP increases and cataract formation from off-label corticosteroid use."
Dr. Paggiarino referred to a study conducted by the Diabetic Retinopathy Clinical Research Network using laser and triamcinolone in DME and is now in follow-up. "This trial confirms the value of laser in DME," Dr. Paggiarino said. "However, a significant proportion of patients still lose vision over time."
retinalphysician.com
In closing here is the best understanding of the subject
matter of DME and steriods that I have run into
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They are hoping that by lowering the dose and getting the implant far away from the lens
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Message 25927918
retinalphysician.com
regards
John |
