By Erik van Rens, M.D.
With the advent of recent pharmaceutical developments new treatment options have become available to treat some very common eye diseases.
Patients with age related macular degeneration used to experience progressive loss of reading vision because of the growth of abnormal blood vessels right in the center of vision.
At the time, only laser treatments were able to stop or slow the vision loss, but re- sults were often a disappointment.
A new class of drugs called vascular growth inhibitors or anti-VEGF was developed to stop the bleeding and leaking and this class of drugs could be injected in the eye, with significant better results. Often there was even vision improvement.
These drugs need to be injected at frequent intervals, sometimes every month. Most patients need these shots for years on end. With many thousands of patients at around $2000.- per shot this turns out to be a billion dollar cost to the insurance industry and medicare. Other patients needing these injections are those with diabetes.
Type 1 diabetes patients acquire the dis- ease at a young age; type 2 patients develop their disease later in life.
Risk factors include being overweight and lack of exercise. Now that a third of Americans are severely overweight we now see an epidemic of diabetes, and with it the associated complications such as eye dis- ease, renal failure, and cardio-vascular dis- ease like heart attack and stroke.
Eye disease- diabetic retinopathy- is associated with growth of abnormal blood vessels, bleeding, and leakage into the central vision area with resultant vision loss.
Here too anti-VEGF shots are a great help, but as in AMD, these shots need to be given at regular intervals and for a very long period of time. Obviously, this too represents a large part of the total expenses for medicare and private insurance carriers.
The total bill for anti-VEGF drugs runs in the billions, and it rises every year. This dwarfs the cost for the actual doctors visit and the cost of the various in-office tests that are necessary to come to an evaluation and treatment plan.
Thanks to the drug industry, our patients with AMD and diabetic retinopathy now get much better treatments resulting in better outcomes, but this comes at a cost to us all. The price of these drugs is significant lower in Canada and in Europe, where governments negotiate the cost of these drugs to the consumer.
New drugs are in the pipeline, and it is expected that these too will come with a big price tag. Existing drugs such as eye drops have gone up in rice dramatically as well.
The bottom line is how much is society willing- and able – to pay before the situation becomes untenable.