Don't know if this pertains to your saying "the feeling that [they?] really don't care" but I'm very disturbed by different (contradictory) comments I've gotten from different retinal specialists.

I've done a great deal of research about these eye diseases which lead to loss of VA (visual acuity) and the studies purporting to compare outcomes according to type of treatment chemical, intervals administered, and combinations thereof.

Almost all (except Avastin) of the injection chemicals are extremely expensive but these costs, including insurance coverage, make a major difference in doctors' choice of modality. Also (overlapping) how much their offices are at risk of economic loss according to what treatments are used (their practices can lose money if the patient is unable to cover the cost). This business angle and conflict of interest is very little acknowledged.

Practices buy in bulk, billing patients and their insurance more than the actual per patient cost, but, they don't discuss how this factor affects both outcomes and effectiveness ("treatment burden" being little discussed in terms of their choices).

I've encountered many times the important factoid that patients in clinical practice are "under-treated" compared to clinical studies wherein their vision is better preserved by more frequent injections. I'm on the point of going to yet another specialist to protect my vision, by finding one who will help me make the best possible decisions, accounting for their widely varying expertise and honestly dealt with economic factors.

I'm especially struggling to inform myself (and related interventional cardiac surgeons) in order to maximally protect my vision for as long as possible. Sadly, wet macular degeneration is incurable and always ends in blindness but there are major differences in the rate at which it develops. That is much a function of the use of anticoagulant medicines which are used to reduce the risk of stroke from arhythmias.

There are other ways to deal with stroke risk but retinologists are rarely informed about the connection between oral anticoagulants and the retinal bleeding they promote. Even if they are, they don't help patients make the critical cost/benefit decisions in conjunction with relevant cardiac specialists. Alternate treatments to the oral anticoagulants, reduce the risks of those suffering from "wet" macular degeneration (e.g., the Watchman Procedure, which I'm most investigating, can reduce the increase in retinal bleeding aggravated by the oral medicines) Thus, the patient can be protected against stroke caused by abnormal heart rhythms, without the ocular dangers of oral anticoagulants.