By Jojo Santo Tomas
Pacific Daily News
santotomas@guampdn.com
What it boiled down to, says 64-year-old Gail Reichenberger, was hope.
Until early last week, Reichenberger was going blind. She was in the later stages of diabetic retinopathy, a serious condition caused when diabetes damages the light-sensitive part of the eye called the retina. Left untreated, patients with diabetic retinopathy can go blind.
So Reichenberger felt she had a choice: slowly go blind or try a new, barely tested procedure that is not approved by the Food and Drug Administration. She chose the procedure, she says, because it sounded better than the alternative. Today, just 11 days later, she's glad she did.
“I feel good now. There were no side effects to it, except the eye got red, but that cleared up in three days,” the Yona resident says. “My vision went from 20-40 in that eye to 20-25 five days later. It worked so fast, I didn't realize that it would.”
The experimental procedure involves injecting a drug called Avastin directly into the eyeball. The drug slows the production of fragile, abnormal blood vessels that can damage the retina. What is surprising about this procedure is that Avastin was originally created to fight colon cancer.
Dr. David Parks, a California-based eye surgeon who has also run an office on Guam for the last seven years, decided to try the procedure on Guam for the first time during his visit last week. He says he injected Avastin into 25 Guam patients, and about 200 patients total since September.
“The results have been very, very good. There are people who don't expect any type of improvement who get it. In my Guam patients, some saw effects within three days,” says Parks. “Some get great improvement, some get modest improvement. This is turning into a very nice medical treatment, a good way to stabilize the eye. But yes, there are still some potential long-term complications that we don't know about.”
Parks says he is the only ophthalmologist on island who is using the procedure, but that he has discussed it in detail with another eye surgeon at the Island Eye Center.
The off-label use of Avastin is growing since it was first presented at a Retinal Society meeting in Montreal last July. It works better than anything doctors do now, says Parks. He guesses he's in the top 20 percent of Avastin usage among eye surgeons and says he will continue to use the drug.
“The first guy that did it injected it into a human eye without knowing (whether) it would be toxic,” says Parks. “I was not the first and would never want to be the first. Nevertheless, they did and their results appear to work.”
Besides patients with diabetic eye conditions, Parks says that Avastin also seems to work on patients with other eye problems.
Guam's prevalence for diabetes is high -- more than 20 percent of the population. And, according to Pacific Daily News files, about 30 percent of Guam diabetics will develop diabetic retinopathy. Using 150,000 as a population base, that means about 9,000 people here are in danger of going blind.
Guam's high rate of diabetes, combined with the fairly inexpensive cost of an Avastin injection, spurred Parks to try the injections here. Parks says a similar drug that is in its final stage of FDA approval, Lucentis, might cost substantially more -- perhaps as much as $900 per dose, while Avastin costs about $50 per injection.
“The advantage of using Avastin is that it reduces the risk of blindness and, consequently, reduces the need for surgery. But it's still not considered the normal way to treat patients with these conditions,” says Parks.
Along with the new procedure, Parks also brought a long consent form, written by an attorney from a malpractice company. Guam patients who sign it acknowledge that Avastin is a drug that is untested by the FDA for vision purposes, and that they also understand that Dr. Parks does not know if there will be any future side effects.
“That's why I was reluctant to sign at first, because it's not FDA-approved. It was absolutely scary for me; I had to think, 'What am I getting myself into?'” says Cecilia Flores, who has suffered from diabetic retinopathy and eye bleeds for the last three years. “Like any other medication, it may have side effects, but what did I have to lose? It does say on the consent form that it may lead to blindness but if I didn't do anything, well, I still might go blind.”
The 59-year-old from Barrigada Heights says she underwent laser treatment three times per year for the last two years to zap away blood vessel growth. She says recovery from laser treatment was uncomfortable.
Last week, she says her eye was covered in blood. But when she got the Avastin injection, the blood cleared up and her vision improved slightly. She still has a cataract that needs to be treated, but says she thinks that when that is removed, her vision will improve even more.
“I've been a diabetic since 1981 and I was fully aware that diabetes could lead to blindness. It did scare me, but controlling the eating was so hard!” she says. “Now, I'm watching what I eat and I'm trying to get more exercise. I don't want to go blind.”
The only drawback with the procedure, says Reichenberger, is that she'll need an injection every four months to fight the abnormal blood vessel growth. However, undergoing the painless treatment three times a year is a small price to pay for sight.
“If it can help a lot of people, it is something to go for and try because without it ... you know the prognosis. It only goes one way and it only gets worse, so I might as well do it,” Reichenberger says.
“Dr. Parks is an excellent eye doctor. I've seen him for many years and I trust him. I don't think he'd go out on a super thin limb if he didn't have an understanding of potential dangers. I think the risk would be extremely small if he decides to use it on his patients.”
Originally published February 18, 2006