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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8321
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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When one is dx with "wet" Macular Degeneration and is on high

Resolved Question:

When one is dx with "wet" Macular Degeneration and is on high doses of anticoagulants to keep coagulation VERY low, will that combination come together to make the MD difficult to treat? Will the leaky extra vessels leak more fluid, more freely than if blood coagulation were normal?
Also, What are the "shots" that would be advised to be taken to manage this situation? The doc even sent a call to go right away after he had seen the woman to see the doc NOW!
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

I am a retina surgeon and treat patients with wet macular degeneration (wet armd) who are on anticoagulants all the time.

Dr. Rick :

Being on blood thinners, aspirin etc do not make the wet armd any worse, the vessels bleed more or leak more. It doesn't work that way.

Customer:

why doesn't it work that way? Why do they bleed to start with. What makes them be wet and not dry?

Dr. Rick :

There are currently three drugs, all of which are fairly similar in how they work, used as injections for this condition. They area called avastin, lucenits and afibercept.

Dr. Rick :

Of the three, I tend to use avastin the most in my retina practice.

Customer:

If they give injections for the bleeding, will the injections make her bleed from the injection site

Customer:

Why do you use avastin? What does it do? Destroy the vessel or coagulate the blood or both?

Dr. Rick :

That is good question and the answer is very complex........here is a very good web page from very respected source that can tell you this faster then I can type it:

Dr. Rick :

The needle is very small, 30 gauge, and put through the wall of your eye where there are very few blood vessels. While there is a higher risk of bleeding, or getting a subconjunctival hemmorrhage (which is really just a cosmetic issue) the injection is not really that much more risky when you are on blood thinners.

Dr. Rick :

I give this injection to patient on blood thinners frequently and have not had a problem since this treatment became available in 2006

Dr. Rick :

Do not let the fact that you are on blood thinners delay getting an injection for your wet armd.

Dr. Rick :

The doctor (sounds like she saw an optometrist) was correct in getting your friend to the ophthalmologist/retina specialist ASAP.

Dr. Rick :

The faster the leakage is stopped the better the chance of saving her central vision.

Customer:

She bleeds at a little stick and we have to sprinkle some powder that keeps the bleeding at bay.

Dr. Rick :

I use avastin because it works well and it is priced over a thousand dollars cheaper per shot then the other meds.

Dr. Rick :

She will, really, be fine with the injection into her eye. I've been doing retina for over two decades and these shots since they were invented and your friend will be safe to have this vision saving treatment even when she is anti-coagulated.

Customer:

OK, I will trust what you say. We need some information to know what to talk to the doc about. What is the damage possible to the retina

Customer:

I am wondering if it can cause a retinal detachment. She said the doc talked to her in terms of pouches of blood in her eye today.

Dr. Rick :

She could loose her central vision, causing her to become "legally" blind (less then 20/200 vision) but it does not affect her side vision so she would not become "lights out" blind from this should she choose not to have any treatment done.

Customer:

That is the worse case scenerio

Dr. Rick :

One of the risk of sticking a needle in your eyeball is a retina detachment. That has happened to me, but as a retina surgeon I fixed it right away.

Customer:

OK

Customer:

Anything else I should know to ask her doctor tomorrow.

Dr. Rick :

The worst case scenerio? She gets an infection in the eye, called endophthalmitis, from the injection and looses the entire eye.

Dr. Rick :

Review that web site I gave you on macular degeneration.

Customer:

how often would she need to take the shots

Dr. Rick :

Is she going to a retina specialist?

Customer:

yes

Dr. Rick :

Depends on how she does. Usually every 4 weeks for 3 months, but the protocols vary on how she responds.

Customer:

we live in boulder Co. do you know one out here

Dr. Rick :

Good.. A retina doc is best trained to do this, although many general ophthalmologists can, and do, give these injections safely.

Customer:

no she was referred to a retinologist.

Dr. Rick :

There are tons of eye doc's and retina specialists, as well as the medical school......but, I'm sure that the retina doc she is seeing tomorrow will be fine.

Dr. Rick :

Same thing...

Dr. Rick :

That is what I am.

Customer:

OK, I appreciate your information. I didn't "get it" when it came to the relationship of anticoagulants -really high doses- or none, to the bleed.

Dr. Rick :

I'm over a thousand miles from Boulder so I don't know any of them personally although I see a lot of retina docs from there at our yearly meetings.

Dr. Rick :

The anticoagulants, either high, low or none, do not really fit into this issue at all. Give them no thought.

Customer:

I will go to your web now. Thank You so much. OK, so you know they exist here? The joke here is that any of us move here to ski, not to work!! Good Night

Dr. Rick :

Yup. Even retina docs live in Colorado.....easy to get pot there ;-)

Dr. Rick :

Have a good night and please, give my best to your friend.

Dr. Rick :

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Expert:  Dr. Rick replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Customer: replied 1 year ago.
Her cardiologist office said she shouldn't have this procedure on plavix? What is the discrepancy? She is in much distress this AM.
Expert:  Dr. Rick replied 1 year ago.
Her cardiologists office is mistaken. Whoever she spoke to must not understand the procedure for her eye.

I assure you I am correct.

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Customer: replied 1 year ago.
The whole lot finally agreed with your information (surprised?). It is because it is not a blood procedure? I couldn't get your web page to respond last night or today, but Comcast isn't very reliable here. I just have to learn more about this issue. I plain don't understand why the vessels grow and why they leak blood and why they are exempt from the effects of coagulation. I look forward to learning more about this. Thanks again for
Your help and patience.
Expert:  Dr. Rick replied 1 year ago.
My pleasure.

Don't forget: If you don't mash the positive feedback button (the one labeled "excellent" is the most fun to push by far) then I do not get compensated for helping you. And I can assure you, my office fees are an order of magnitude higher then here on this webpage :)

I'm glad your friend did not have a delay in this very-time sensitive treatment due to some poor information from the cardiologists office....

I wish her the very best.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8321
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year ago.
Hi,

I was just thinking about your friend today and wondering how her visit to the retina specialist went. Did she have an injection?

If you wanted, I would be happy to go over her clinical notes, OCT test results and treatment plan if you uploaded the data to me. Let me know if there is anything else I can do for you.

Dr. Rick

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Dr. Rick
Dr. Rick
Eye Doctor
8321 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest