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News, International

Fears AMD injections could cause glaucoma

28/05/2019By Callum Glennen
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Patients in British Columbia, Canada, will continue to receive anti-vascular endothelial growth factor injections despite concerns from the region’s medical community the treatment could be causing severe glaucoma.

A media release from the Ministry of Health and the Provincial Health Services Authority of British Columbia stated that the use of Avastin injections to treat neovascular age-related macular degeneration (nAMD) will continue, and the initiative has the support of 29 retinal specialists from the Provincial Retinal Diseases Program, as well as two glaucoma specialists.

Concerns regarding the program first emerged last week, when The Globe and Mail reported the British Columbia Society of Eye Physicians and Surgeons (BCSEPS) had hired a lawyer as part of an attempt to have the treatments stopped.

BCSEPS reportedly submitted its concerns to the government during February 2019, giving a deadline of 24 May 2019 to address the issue.

When the deadline was passed, BCSEPS engaged legal advice.

Adrian Dix
Adrian Dix
“While there may be a level of risk associated with the treatments, suspension of the program and the resulting lack of provision of these injections would pose a serious risk”
Adrian Dix, BC Gov

Concerns arise from the government-funded use of Avastin, or bevacizumab, injections to treat nAMD. The drug is not approved by Health Canada to treat the condition, but is regularly prescribed off-label as a cheaper alternative to approved drug Lucentis.

However, Avastin is sold in large vials that require pharmacists to split it into dosage-sized syringes.

According to the email sent by BCSEPS, evidence suggests an unidentified toxin from the syringes is leeching into the drug, resulting in increased incidents of severe glaucoma requiring surgery.

BCSEPS also claims that specialists across British Columbia have reported an increase of glaucoma among patients who have received the injections at a rate not been seen in regions that do not have the program.

The Provincial Retinal Diseases Treatment Program has been in place in 2009, and has treated 20,000 people.

The government has defended the initiative, will inform patients of the possible risks of glaucoma and has requested an external review.

“We have decided to move forward continuing the program based on the recommendation of the specialists, who have indicated that while there may be a level of risk associated with the treatments, suspension of the program and the resulting lack of provision of these injections would pose a serious risk of further deterioration of vision and possible vision loss in patients,” Mr Adrian Dix, minister of health, said.

According to the Ministry of Health, concerns of the program were first brought to the attention of the Provincial Health Services Authority in 2017, and a quality review was initiated in 2018.

The review was unable to corroborate an overall increased rate of glaucoma surgery.

 

More reading:

European court approves off-label Avastin use for AMD following extended legal battle
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