Dr. John Haley, MD, speaks to the growing demand for intravitreal injections and the need for a standard of care when packaging and administering these medicines.
Video Interview: Intravitreal Injections - Seeking a Standard of Safety
Dr. Wendy Lee Interview with Dr. John Haley
Dr. Wendy Lee: Hi, I'm Dr. Wendy Lee, editor for OphthalmologyWeb.
Today, we're here with Dr. John Haley from Dallas Texas. The topic of today's interview is intravitreal injections. This is a topic that's gained a lot of interest lately. Dr. Haley, in your experience, why has this method of drug delivery become so popular?
Dr. John Haley: Well, Wendy, as you know, there will probably be approaching three million intravitreal injections in the United States this next year, and the reason is it's become the standard of care for many retinal diseases, including macular degeneration, diabetes, diabetic macular edema, and vein occlusions.
Dr. Wendy Lee: So, tell me what the risks are involved in intravitreal injections?
Dr. John Haley: Well, there are many risks; fortunately, they're uncommon. The biggest risk is endophthalmitis, which occurs in about one in 2,000 cases.
Dr. Wendy Lee: Okay.
Dr. John Haley: But, there are many other less common risks, like retinal tear, retinal detachment, retinal hemorrhage. These are the mechanical problems, but you also have complications from the drug itself and abnormal properties of the drug.
Dr. Wendy Lee: Um-hmm.
Dr. John Haley: For instance, some--it's just been recently shown that some macromolecules can plug the trabecular meshwork and cause temporary or long-term glaucoma.
Dr. Wendy Lee: Okay, so there are some safety measures as far as handling and shipping of these intravitreal injections that need to be considered.
Dr. John Haley: Yes.
Throughout the industry in the last few years, due to pricing concerns, there's been a race to the bottom--.
Dr. Wendy Lee: --Um-hmm--.
Dr. John Haley: --Who can produce the Avastin compound the cheapest, and with this has become shortcuts. Many of the compounded pharmacies do not use the Millipore filters. They do not use the highest quality Luer-Lok syringes and needles.
Dr. Wendy Lee: So, how do we increase awareness amongst physicians as to which compounding pharmacies are reliable and safe with these intravitreal injections? Is it standard now that everyone who makes these intravitreal injections must go through this strict safety process?
Dr. John Haley: And these standards are just becoming available, so it's up to the surgeon to check this out--.
Dr. Wendy Lee: --Right.
Dr. John Haley: Don't just ask for the cheapest price; follow the rules.
Dr. Wendy Lee: Um-hmm.
Dr. John Haley: Ask them what their process is. And if you really want to know, go see their process.
Dr. Wendy Lee: Right. Okay, great.
What tips can you offer physicians for safe injections of intravitreal medicines?
Dr. John Haley: Well, there are many different protocols, and at the Retina Meeting in the last few days it was apparent that there is no standard. There are many different standards. There are many different techniques of anesthesia. There are many different techniques of the injection. The injection site is standardized at three-and-a-half to four millimeters posterior to the limbus, but--.
Dr. Wendy Lee: --Um-hmm--.
Dr. John Haley: --Some use speculums, some use preoperative antibiotics, some use Betadine--most do--.
Dr. Wendy Lee: --Um-hmm--.
Dr. John Haley: --But, it's all up in the air, and we really don't know the best and safest way to do injections--.
Dr. Wendy Lee: --Um-hmm.
So, I understand, Dr. Haley, that you have created an educational video outlining some of the safety guidelines for use of intravitreal injections. Can you tell us about that process?
Dr. John Haley: We have a compounding pharmacy in Dallas called Dougherty's Pharmacy that has set a very high standard in their compounding of Avastin, and they really have created the process and created the video.
Dr. Wendy Lee: Can you tell us a little bit about that process?
Dr. John Haley: I do know that they have the very best compounding hoods--.
Dr. Wendy Lee: --Um-hmm--.
Dr. John Haley: --To isolate the material. And then, they insist on Millipore filtering of all the product, and then very strict sterile controls and--.
Dr. Wendy Lee: --Um-hmm--.
Dr. John Haley: --Strict shipping standards, and I think those make a difference.
Dr. Wendy Lee: Well, great. That's exciting news. Thank you so much for being with us today, Dr. Haley.
Dr. John Haley: Thank you, Wendy.
Unidentified Man: For added safety, Dougherty's Pharmacy recommends physicians use the InVitria injection assistant from FCI Ophthalmics. The InVitria provides predictable, safe and simple delivery of anti-VEGF medication.