i am writing this post with the help of ChatGPT, but the thoughts, experience, and frustrations are ours.
One of the pressing challenges in our region is the scarcity of **Avastin (bevacizumab)**—a cost-effective anti-VEGF agent that has transformed the management of diabetic retinopathy and diabetic macular edema (DME) worldwide. Its limited availability has forced both physicians and patients to rethink how this disease is managed.
The First Line of Defense: Sugar Control
Before any advanced therapy comes into play, the foundation remains **strict glycemic control**. Regular monitoring with **HbA1C** gives a reliable picture of long-term glucose management. Without this step, even the best eye treatments cannot prevent progression.
Panretinal Photocoagulation (PRP) Still Matters
For proliferative diabetic retinopathy, **panretinal photocoagulation** remains the backbone of therapy. PRP is not new, but it is reliable in reducing the risk of severe vision loss when newer drugs are unavailable.
Filling the Gap: Suprachoroidal Triamcinolone
In the absence of affordable anti-VEGF therapy, some physicians have turned to **suprachoroidal triamcinolone acetonide** for treating DME. This approach is innovative, and evidence from other settings supports its use:
* Suprachoroidal delivery has been shown to target the posterior segment more effectively while limiting anterior chamber exposure, potentially reducing risks like cataract and glaucoma [[Campochiaro et al., 2018](https://pubmed.ncbi.nlm.nih.gov/29860434/)].
* Studies in the PEACHTREE trial demonstrated significant visual improvement in patients with macular edema using this route [[Boyd et al., 2020](https://pubmed.ncbi.nlm.nih.gov/32146077/)].
However, **it is not without complications**. Risks of elevated intraocular pressure, endophthalmitis, and rare injection-related adverse events remind us that this is a compromise, not a perfect solution. For both physicians and patients, it can be a frustrating situation.
### A Way Forward
Scarcity of Avastin should not mean scarcity of hope. The way forward lies in **joint efforts**:
* **Physicians** must prioritize early referral—sending patients for regular fundoscopic exams before irreversible changes set in.
* **Patients** must commit to lifestyle changes: balanced diet, regular exercise, strict adherence to insulin or oral medications, and management of associated conditions like hypertension and dyslipidemia.
* **Collaborative care** between diabetologists, general physicians, and ophthalmologists can bridge the treatment gaps.
We may not have all the tools we want, but by strengthening the basics and sharing responsibility, we can still protect patients from avoidable blindness.#best laser eye surgery in Pakistan
#eye clinic
#eye checkp
#eye dr near me
← Back to all posts