Injecting premature babies with chemotherapy to "prevent blindness"

[rambone]

Sorry I'm late to this thread, but I think I can shed some light here. I have 24+ yrs private practice Optometry experience, dealing with many hundreds (maybe thousands, whose counting?) of patients with vascular eye issues.

Thanks for showing these children how a grown up contributes to a discussion.

I understand that you have worked on many eyes, does that include preterm babies? Aren't there any extra concerns when working on a preterm baby's eyes?

Is it not true that the majority of these babies do not need the Avastin treatment?

Is it unfair to presume that eye treatment will be recommended for premature babies, regardless of their actual ocular condition? A "pre-emptive" cure to a disease that may or may not be present?

There are no "guarantees" with the human body or it's treatment. It never ceases to amaze me why some people look for every reason not to accept a treatment modality, when the chances of success are overwhelmingly higher! Rambone apparently has an axe to grind with the medical community in general. A little bit of knowledge can be a dangerous thing....

I am just tired of the side-effects being glossed over as if they never happen. I'm done falling for that one.

Did I correctly list the side-effects to intravitreal eye injections? Is it unimaginable that a preterm baby's eye would become infected and threaten its life? Is that not a concern?

Perhaps under a less skilled doctor's care, do complications ever become a concern?

Thank God for the advances that modern medicine under our capitalist system has been able to produce!

 

[jpo117]

Is it unfair to presume that eye treatment will be recommended for premature babies, regardless of their actual ocular condition? A "pre-emptive" cure to a disease that may or may not be present?

Could you point out where you presented any evidence of this? It seems to be the major sticking point here, but after reading through the original article I don't see anything recommending this treatment indiscriminately. You didn't address this issue before when it was brought up; could you now?

Without any evidence supporting this claim, I really don't see what the point of this thread is.

 

[rambone]

Could you point out where you presented any evidence of this? It seems to be the major sticking point here, but after reading through the original article I don't see anything recommending this treatment indiscriminately. You didn't address this issue before when it was brought up; could you now?

Without any evidence supporting this claim, I really don't see what the point of this thread is.

The answer to that question appears right in the headline. They plan to "prevent blindness", meaning, they are doing this procedure before signs of blindness are present.

They also said they chose 150 premature babies at random and gave them all treatments. Random selection means that they aren't requiring any confirmation about the child's visual state to issue the treatment. And since the baby can't read an eye chart, I doubt that there is much that they can do to tell which 5% "need treatment" and which 95% don't. But we'll see what sftn6 says regarding that.

 

[redneckmedic]

[ame=http://www.youtube.com/watch?v=Db_S5iYFSY4]YouTube - Life as an Akatsuki: the song that never ends[/ame]

 

[tyler34]

it's preventative medicine, pretty standard stuff. when I had cancer part of my course of treatment was cranial radiation. while it didn't have anything to do with the treatment for the cancer it was preventative in case my cancer ever comes back because when it does it 95% and up of the time comes back in the brain. were there sides effects? too many to count and some have negatively impacted my life. is there anyway for a doctor to be able to predict who will have a relapse of cancer and when that will happen? no. looking back was/is it worth the side effects at the time and currently? hell yes. doctors can't predict when and to whom ailments befall people, what they can do is preventative medicine to ensure that a lesser percentage of people have to even think about it happening to them.

 

[eldirector]

The answer to that question appears right in the headline. They plan to "prevent blindness", meaning, they are doing this procedure before signs of blindness are present.

They also said they chose 150 premature babies at random and gave them all treatments. Random selection means that they aren't requiring any confirmation about the child's visual state to issue the treatment. And since the baby can't read an eye chart, I doubt that there is much that they can do to tell which 5% "need treatment" and which 95% don't. But we'll see what sftn6 says regarding that.

Oh, for cripes sake.... RTFA. Bold added in the quotes below for the reading impaired.

The study, reported in The New England Journal of Medicine, showed that a single injection of Avastin into the eyes of premature babies prevented blindness more effectively than laser surgery, the usual method used when there are signs of problems.

In the study, 150 premature infants were randomly assigned to have their eyes treated with injections or with lasers. All had advanced retina damage in the zones of the retina nearest to the optic nerve, which carries information from the eye to the brain.

If you are going to expect ANYONE to take you seriously, at least read (and maybe even comprehend) the article you are quoting.

 

[ElsiePeaRN]

As fun as this is, I would suggest that we back off Rambone. I'm glad that we hashed this out and had facts presented from parents and a doctor and we'll all be able to make a more informed decision if we are ever faced with this nightmare. For now, I need to go tell a friend about all this as his wife has macular degeneration and I have no clue what kind of treatment they have been using so far.

, , and

 

[shftn6]

Thanks for showing these children how a grown up contributes to a discussion.

I understand that you have worked on many eyes, does that include preterm babies? Aren't there any extra concerns when working on a preterm baby's eyes?

Is it not true that the majority of these babies do not need the Avastin treatment?

Is it unfair to presume that eye treatment will be recommended for premature babies, regardless of their actual ocular condition? A "pre-emptive" cure to a disease that may or may not be present?




I am just tired of the side-effects being glossed over as if they never happen. I'm done falling for that one.

Did I correctly list the side-effects to intravitreal eye injections? Is it unimaginable that a preterm baby's eye would become infected and threaten its life? Is that not a concern?

Perhaps under a less skilled doctor's care, do complications ever become a concern?

While preterm babies are not a part of my practice - virtually all of those are seen by Riley - I am very familiar with ROP retinopathy, and the bottom line issue (retinopathy) is the same as diabetic retiniopathy and macular degeneration, which I deal with on a daily basis.

The study which came out recently in the New England journal of Medicine dealing with this issue dealt only with patients (infants) who had already developed retinopathy. Only 6% of the Avastin treated infants had a recurrence of retinopathy, vs 40% receiving laser treatment, and I would estimate a recurrence rate of virtually 100% in untreated eyes - pretty good odds of a good treatment effect!

Treatment would not be recommended for those who did not show retinopathy - this is referred to as "prophylactic" treatment. In these cases, the risks of treatment, which you mention, although extremely small, simply outweigh the benefits in an eye without retinopathy.

You have got to realize how these FDA drug trials are conducted. Every study participant on an experimental drug has to fill out an exhaustive questionaire on side effects - "did you experience any of the following symptoms during your course of treatment?" Patients are required to list ANY unusual symptoms they experience during the course of treatment, whether they or their doctors think they were related to the drug or not. By law, any symptom experienced by any participant (for any reason, regardless of whether causality is proven or not) has to be listed on the package insert as a "potential side effect". Do you ever wonder why "blurred vision" is listed as a side effect on virtually all medicines? It's because if the study has any size to it at all, SOMEONE in that study is probably going to have refractive changes in their prescription during their time in the study - viola!, blurred vision is listed as a side effect.

The side effects you list are all possible with this treatment, but the chance is miniscule - way less than 1 in 1000. The chances of blindness in an untreated eye with retinopathy - virtually 100%. Complications are ALWAYS a concern. Nothing is black and white in dealing with the human body. There is far more gray than black or white in this business. But, you play the odds, and make the best decisions you can with the available information.

 

[jpo117]

The answer to that question appears right in the headline. They plan to "prevent blindness", meaning, they are doing this procedure before signs of blindness are present.

Are you suggesting that medical treatment to prevent blindness should not be administered until signs of blindness are present? So infants that are diagnosed with a condition that often causes blindness when left untreated should not receive treatment until there are indications that they are blind? Do you think that medical treatment to prevent death should be withheld until there are observable signs of death?

They also said they chose 150 premature babies at random and gave them all treatments. Random selection means that they aren't requiring any confirmation about the child's visual state to issue the treatment. And since the baby can't read an eye chart, I doubt that there is much that they can do to tell which 5% "need treatment" and which 95% don't. But we'll see what sftn6 says regarding that.

eldirector already showed that this statement is completely false.

Back to your original quote:

Is it unfair to presume that eye treatment will be recommended for premature babies, regardless of their actual ocular condition? A "pre-emptive" cure to a disease that may or may not be present?

Do you have any evidence that this treatment would be used indiscriminately with no regard for whether the treatment is needed or not?

 

[Kick]

I read this thread thinking that I may actually learn something.

Thank you Kirk Freeman for posting that one thing I was actually able to learn.

 

[jsharmon7]

Oh, for cripes sake.... RTFA. Bold added in the quotes below for the reading impaired.

If you are going to expect ANYONE to take you seriously, at least read (and maybe even comprehend) the article you are quoting.

I think all of the technical aspects of this thread have been discussed by actual doctors, thank you shftn6. I just wanted to quote this man and add that from what I can tell, rambone does NOT actually read and understand the things he posts. He finds inflammatory headlines, sometimes from other countries or from years ago, and posts them up as gospel. The funny part is that in addition to people who argue with him, there are quite a few that consistently jump in and agree with him and the article, thereby proving that they too failed to read and understand the article. It's very special.

 

[rambone]

The study which came out recently in the New England journal of Medicine dealing with this issue dealt only with patients (infants) who had already developed retinopathy. Only 6% of the Avastin treated infants had a recurrence of retinopathy, vs 40% receiving laser treatment, and I would estimate a recurrence rate of virtually 100% in untreated eyes - pretty good odds of a good treatment effect!

Their wording lost me when they said they chose the premature babies at "random". If they only treated babies with ROP developed then that is better than the way I interpreted it.

Treatment would not be recommended for those who did not show retinopathy - this is referred to as "prophylactic" treatment. In these cases, the risks of treatment, which you mention, although extremely small, simply outweigh the benefits in an eye without retinopathy.

The side effects you list are all possible with this treatment, but the chance is miniscule - way less than 1 in 1000. The chances of blindness in an untreated eye with retinopathy - virtually 100%. Complications are ALWAYS a concern. Nothing is black and white in dealing with the human body. There is far more gray than black or white in this business. But, you play the odds, and make the best decisions you can with the available information.

I concur. Thank you for the thoughtful responses.