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The Question
05/03/06 09:19 PM

"What are the latest drugs being used for injections for treatment of retinopathy? Is one called avastin? Do the steroid injections affect blood sugar and blood pressure? Can cataracts be a side effect of either drug? If cataracts form are they treated differently for a diabetic?

Just had an exam with dilation and they want another examine in 2 weeks. Are there any side effects from frequent dilations?"

Asked By: hynekip  
Category: Vision

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Expert Answers (1)

05/03/06 09:19 PM

Three injected medicines are currently being investigated and used for the treatment of proliferative diabetic retinopathy and clinically significant diabetic macular edema, the most serious forms of diabetic retinopathy: Avastin (TM), Lucentis (TM), and Macugen (TM). These drugs belong to a category of agents called VEGF inhibitors (VEGF = vascular endothelial growth factor), which turn off the biochemical messengers responsible for abnormal blood vessel growth. Avastin is far less costly than the other drugs and appears to be equally or more effective; however, it was developed for treating certain kinds of colon cancer and is not FDA-approved for use in the eye. Although these drugs are promising and appear safe, there are potential, serious systemic side-effects, especially with respect to Avastin; laser photocoagulation is still the 'gold standard' of treatment for vision-threatening retinopathy.

Another category of medicines now being routinely used to treat severe retinopathy are corticosteroids - which may be injected or implanted within the eye. These have the effect of reducing inflammation that is often associated with retinopathy, particularly macular edema. Steroids can raise blood sugar and pressure if they reach the circulatory system, but steroids injected into the eye are not expected to reach the bloodstream in sufficient concentrations to have significant effects; however, there are few studies investigating this possibility. Both cataracts and elevated eye pressure, which can cause glaucoma, are common side-effects of intraocular steroids. Cataracts in patients with diabetes are treated the same as with other patients, by surgical removal, though the risk of surgical complications with diabetes is higher.

As for dilating drops, they are metabolized quickly by the liver and kidneys. There are no known ophthalmic or medical complications associated with frequent dilation of the eyes.

A. Paul Chous, MA, OD, FAAO



Diabetes Eye Specialist
Tacomoa, WA
type 1 diabetic diagnosed 38 years


And be sure to check out Dr. Chous' site, DiabeticEyes.com
Financial Disclosure

Answered By:
Accreditations: MD
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*** All information contained on dLife.com is intended for informational and educational purposes only. Our Expert Q&A is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

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