Retinopathy Update Part II – The Appointment

Well, I saw my ophthalmologist today.  It was a pretty good appointment overall, I guess.  If nothing else, the good definitely outweighed the bad.

As you may recall, my main “concerns” for this appointment involved (a) the possibility of further proliferation of the retinal blood vessels, and (b) the risks and rewards of Avastin shots.

Thankfully I got the “all clear” on the proliferation issue!  Whew!  That was a big load off my mind, particularly since my optometrist had instilled some fear in me relating to this at my last check-up.  Today the ophtho confirmed that the network of vessels the optometrist had been referring to was the same network that’s been there since my pregnancy (or before?), and not, in fact, a new network like the optometrist had indicated.  Every ophtho appointment I have, I hope and pray that there is no new growth, because that would open up the possibility of all kinds of new bleeds, so it’s always a relief to hear that he’s not seeing any changes.

He mentioned that the little leaky bleeds I’m still having are most likely due to “traction” – or the pulling of the vitreous away from the retina.  Apparently this is normal as we (even you) age, but the weak vessels can’t handle it very well.  I sometimes have worried that this could lead to retinal detachment, but he said he doesn’t see any immediate risk of this for me.  That is also a relief!  I suppose it could be the reason that I’ve been having some flashing in the same general area as the leaks.  He didn’t seem concerned about that either, since it’s only happening occasionally.

We discussed Avastin shots as well.  I was hoping that he would say they were worth a shot (no pun intended), but in the end he told me that they probably aren’t and that he wouldn’t recommend them for me.  That was a bit disappointing because I was starting to anticipate that Avastin might be my best chance of stopping these bleeds so that I can get on with my life and we could consider another pregnancy in the near future. 

I first asked him about the risks of getting Avastin shots, which he explained were (a) a risk of infection, (b) a risk that I would move my eye and he would nick my lens with the needle, and (c) a risk of a haemorrhage in my eye (been there done that – no thanks).  The potential benefits, he said, were sort of uncertain, and were likely temporary.  He explained that normally Avastin is used to treat edema (i.e. swelling) in the eye – which I don’t have (at least not in any significant amount).  It is also sometimes used for proliferative retinopathy like mine, with the goal being to shrink up the leaky vessels.  The problem is, the effect of the Avastin only lasts 2-3 months, and then you’re back to where you started…maybe.

I say “maybe” because there is the chance that those vessels wouldn’t grow back, but there’s also the chance that they would.  In a nutshell, the weak new vessels grow when the retina isn’t getting enough oxygen.  The purpose of laser treatments is to alter the retina (i.e. kill parts of it) so that it doesn’t need as much oxygen.  So if my brain is convinced that my retina is getting enough oxygen, no new vessels grow and everybody’s happy.  But if those weak vessels shrink up thanks to the Avastin, and my brain thinks, “Hey Retina, now that those vessels are gone, you seem to be lacking oxygen again!” then I get more proliferation and we’re back to where we started…or worse, I suppose.  Not good. 

I was hoping that getting some Avastin shots before getting pregnant again would be a good “pregnancy-and-retinopathy strategy”, but it doesn’t appear so.  Obviously he won’t do the shots when I’m pregnant (for the safety of the baby), but if he does it before the pregnancy, at best the treatment lasts through the first trimester.  I wouldn’t be covered for the last two.  (Last time the growth happened during the second trimester.)  As well, my husband pointed out that, if the above-noted regrowth occurs after the Avastin treatments, to couple that with the growth hormones of a pregnancy might make for a double-whammy in terms of proliferation.  I didn’t discuss that with the ophtho, but it makes sense to me…enough sense that I wouldn’t want to risk it.

Either way, my ophtho says that Avastin is not a good pregnancy strategy, nor does he recommend it for me outside of the realm of a possible pregnancy.  While I’m disappointed that it doesn’t appear to be the possible treatment I was hoping for, I can definitely see his point(s) and I have to admit that I’m quite happy not to be facing an impending needle-to-the-eyeball!

So, all in all, the relief in knowing that there’s no new growth is much more significant than the disappointment re: the Avastin shots, and I’d call it a good appointment.

Thanks to all of you who thought of me today! 🙂

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