In Washington, as elsewhere, ophthalmologists brought in the biggest average reimbursements from Medicare.

In Silverdale, Kitsap County, Retina Center Northwest’s three doctors were among the state’s top 50 in total payments. One, Dr. David Spinak, topped the list with total payments of more than $3 million in 2012.

But Dr. Todd Schneiderman, 50, who founded the clinic in 2001 and whose reimbursements came in over $2 million, said the reimbursements reflect in large part payments for the expensive and very effective drugs he and many ophthalmologists use to stop, and even reverse, serious age- or diabetes-related eye problems such as macular degeneration.

“I’m not making $2 million,” said Schneiderman, who noted he drives a 15-year-old SUV. “None of us make a fraction of that money; the vast majority goes to pay for this drug.”

The drugs, in a class called anti-vascular endothelial growth factor or anti-VEGF, include both Avastin and Lucentis, both of which are injected into the eye.

Lucentis is the most expensive, costing the clinic’s doctors as much as $1,950 per injection, Schneiderman said, and nearly all patients need multiple injections.

Schneiderman says he chooses Lucentis most often because he believes it is more effective and, for a few reasons, may be safer, including the need for Avastin to be reformulated by a compounding pharmacy.

“I want to do what I think is best for the patient when I’m sitting there,” he said. “If I have an 85-year-old patient with one eye, there’s no way I’m going to give them Avastin … I’m not feeling like I have a responsibility to the U.S. health system — I have a responsibility to the patient.”

Staff reporter Justin Mayo contributed to this report.

Carol M. Ostrom: costrom@seattletimes.com

or 206-464-2249.

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