Long-term efficacy for DME with fewer injections? Yes, please!

Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Joshua Mali, MD, a vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, FL. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica.

As a physician passionate about treating and helping patients with retinal disease, I continuously seek out and study new treatment modalities. It can be a very scary time for patients when faced with retinal conditions, such as macular degeneration, retinal detachments, and diabetic macular edema (DME). My goal is to calm their fear and anxiety by offering what I know to be the most advantageous and effective treatments available. It is very rewarding for me to guide patients through their treatments as we work to save their vision and provide the best possible patient outcomes. 

What patients want

It should come as no surprise that patients are generally averse to monthly intravitreal injections. This regimen presents a difficult situation for all involved parties: patients, their caregivers, the healthcare system, and the doctors that must see a large base of patients just for monthly injections.

Pharmaceutical companies have heard our pleas for less troublesome, less painful treatment options and emerging retinal pharmacological treatments are addressing the burden of frequent and expensive treatments for DME. After all, diabetes is a chronic disease, and ideally, treatment should mirror that chronic nature.

Enter the fluocinolone acetonide intravitreal implant (Iluvien, Alimera Sciences). The nonbioerodable implant is designed to deliver a continuous microdose of fluocinolone acetonide (FAc) to treat DME. Designed specifically for intraocular use, the tiny implant (3.5 mm x 0.37 mm) lasts for 36 months, and may possibly eliminate, or at least significantly reduce, the need for and frequency of anti-VEGF injections.

During my retina fellowship in Albany (NY), I had the opportunity to participate in the initial launch of the implant. My patients were among the very first recipients, and all have continued to do well. I have been using the device since then, and have injected over 10 patients with the deivce; all have met treatment goals. With the gradual release of medication over an extended period, the implant offers us the pharmacokinetic profile we are looking for to help us to achieve our patients’ visual goals.

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