A trite modern metaphor for the absence of good options refers to those choices that are only “better than a sharp stick in the eye.” I was recently faced with a medical problem where I had to decide whether I had any option superior to a sharp stick in the eye. Let me explain.
Earlier in the year, at age 70, after a routine eye exam, an ophthalmologist at the University of California Irvine, informed me that she had observed drusen in both retinas, confirming a diagnosis of dry macular degeneration. She recommended vitamins and close follow-up. I made a follow-up appointment and began taking giant, difficult-to-swallow, AREDS 2 vitamins twice a day.
The new diagnosis was something that had concerned me for many years, given that my grandfather and his twin daughters, my mother and aunt, had all lost their vision to retinal disease. My brief review of the literature was encouraging. In most patients with dry age-related macular degeneration (AMD) visual loss progresses slowly over years and the AREDS vitamin regimen delays progression in many cases.
But a few months later, while driving, I noticed that my night vision was impaired. Everything seemed darker than normal. The same night, while watching TV, it was obvious that the vision in my right eye was impaired. When I looked at an Amsler grid, there were gray splotches on the right side in a number of locations and waviness in the previously straight lines.
Back at the Gavin Herbert Eye Institute at UC Irvine, optical coherence tomography and fluorescence retinal angiogram studies showed progression to wet macular degeneration.
I was well aware that, in the recent past, there had been no effective treatment for AMD, as exemplified by its course in my family members, who had spent their final years with major visual impairment. Was it time for me to start shopping for a guide dog and a white cane? Did I have any option that might be better than a sharp stick in the eye? The surprising answer provided by retinal surgeon Baruch Kuppermann, MD, of UC Irvine, was that a sharp stick in the eye was, in point of fact, my best therapeutic option. After discussion of alternatives, and the potential risks and benefits of multiple drug options (bevacizumab, aflibercept, and ranibizumab), I elected ranibizumab, and 0.5 mg of the drug was injected into the vitreous humor of my right eye via a 30-gauge needle. How terrible is a sharp stick in the eye? I would rate it a 1 (least painful) on a distress scale of 1 to 10. A paper cut sustained the same day actually hurt a little more.
By the time of the follow-up examination 1 month later, the night dimness had improved substantially, and the gray blotches were gone, although the Amsler grid lines still buckled slightly. On optical coherence tomography, the wet patch in the retina had completely resolved. The fluid has recurred at about 2 month intervals since then, but improves following each subsequent injection.
Well, you might muse, this is interesting, but why am I reading this on Cancer Network? This has nothing to do with cancer. Actually it does.
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