Macular Degeneration and Injections

In my practice, I see patients with macular degeneration. Some of these people need injections in their eyes in order to help their vision. I usually start with the most commonly used injection in America for macular degeneration. If that relatively inexpensive medication doesn’t work, I often switch them to a different medication after three months. Often, the new medication seems to work better than the initial one. According to a recent study in JAMA Ophthalmology by Ferris et al., strategies like this are similar. However, this journal article argues that people often get better if they continue getting injections of the original medication as well! This is really interesting food for thought. Consider my perspective: when I switch medicines and the patient starts to get better, I really like the new medication and am very happy that it is working. The patient usually is happy about this too. However, the patient might have improved even if we hadn’t switched medications as long as they kept taking injections! Right now, we don’t know enough about whether continuing the original medication would work as well as switching to a new medication, but I think that the authors make a really good point that any study of switching medications needs to include a control group that stays on the original medication.