Treatment Options

LASER TREATMENT

Most patients who have severe Coats’ Disease lose blood flow to the retina. Small blood vessels known as capillaries close, and this leads to higher risk of retinal detachment and bleeding. Laser is done to treat these areas of capillary closure that can lead to neovascularization or retinal leakage. It is important to know that the laser is literally “killing” sick retina. The laser is not being used to make vision better. It is preventive. It can only be used in patients who do not have retinal leakage so severe that it has caused retinal separation also known as serous retinal detachment. Laser is done to treat areas of capillary closure that can lead to retinal leakage. Laser can be applied in many different methods. It is used when retina specialists can locate specific areas of retina capillary closure also known as retinal ischemia. Retinal doctors use various tests including fluorescein angiogram, optical coherence tomography, and other tests to locate areas that are safe to treat. Laser cannot be delivered too intensely to the center of the retina where vision is most dependent on healthy function.

Laser and Anti-VEGF drugs (see below) can be used separately, or in combination to treat Coats’ Disease. Laser is “permanent,” meaning that it causes death of the specific area of retina treated to achieve a longer term benefit (stopping leakage). Anti-VEGF drugs are “temporary,” meaning that when the drug wears off, the leakage may quickly return.

Be advised that the patients who get the laser are not cured. Other areas of retina in Coats’ patient may begin to have capillary closure and lead to retinal ischemia requiring additional laser, or addition of Anti-VEGF treatments. Laser can cause loss of vision wherever it is applied. These are called blind spots, also known in ophthalmology as scotoma. The more laser, the more risk of patients noticing blind spots.

Anti-Vascular Endothelial Growth Factor (Anti-VEGF) Medicines

Anti-VEGF drugs (also called VEGF inhibitors) slow the abnormal growth of blood vessels. Anti-VEGF stands for anti-vascular endothelial growth factor.

Anti-VEGF drugs work by interfering with either vascular endothelial growth factor (VEGF) which is a signal protein produced by many cells that stimulates the growth of new blood vessels, or by blocking the VEGF receptor so that VEGF cannot bind to it. VEGF and the VEGF receptor play a major role in the formation and growth of new blood vessels during early embryogenesis and the formation of blood vessels from pre-existing vessels at a later stage (this is called angiogenesis). The formation and maintenance of blood vessel structure is important for the progression of cancer, degenerative eye conditions, and other conditions associated with inflammation.

There are three anti-VEGF inhibitors that may be used to treat eye conditions such as Coats’ Disease. These are

• Avastin

• Lucentis

• Eylea

The anti-VEGF medication is injected into the vitreous gel in the eye (this is the clear gel that maintains the shape of the eye) and targets a protein involved in the formation of abnormal blood vessels that stops the growth of these blood vessels and reduces bleeding. This reduces fluid build-up, improves vision quality, and prevents ongoing damage to the retina light receptors.

OTHER POTENTIAL TREATMENTS

1. Draining of leakage

2. Medications

3. Removal of all or part of the eye (enucleation)