Age-related macular degeneration (AMD) is the most common cause of central vision loss in people 65 years and over. However, treatment with anti-VEGF injections has been shown to stabilize cases of wet AMD, and it can sometimes reverse vision loss.

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AMD occurs due to changes to the macula, which is the part of your retina that enables you to read, see fine details, and recognize faces.

There are two types of AMD: dry AMD and wet AMD. With dry AMD, the macula slowly gets thinner as time passes, and vision gradually gets blurry. With wet AMD, an excess of vascular endothelial growth factor (VEGF) triggers abnormal blood vessel growth under the macula. These vessels leak and can cause rapid loss of vision.

Dry AMD is more common and progresses slower, but wet AMD is more serious. Untreated wet AMD is responsible for most cases of age-related blindness.

This article explains whether anti-VEGF injections are effective for AMD, how they work, and what to expect before and after the procedure.

Fast facts

  • Wet AMD happens when VEGF triggers abnormal blood vessel growth in the eye.
  • Anti-VEGF injections are the most effective way to reduce and sometimes reverse vision loss from wet AMD.
  • An anti-VEGF injection is a fast and relatively pain-free procedure that can be done in the office of an eye professional.
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VEGF causes the formation of small blood vessels. This is important in areas of your body that need good blood flow, such as your lungs. VEGF can also help with wound healing.

However, too much VEGF in your eyes contributes to the overgrowth and leaking of blood vessels, which causes wet AMD.

If you have wet AMD, treatment is aimed at reducing the growth of the abnormal blood vessels under your macula.

Treatments to reduce the amount of blood vessel growth under the macula include:

  • Anti-VEGF injections: These are injections of medication to block VEGF.
  • Photodynamic therapy: This uses light and medication to clot and block targeted blood vessels.
  • Photocoagulation: This involves using a laser to fuse or destroy targeted blood vessels.

Of these three possible treatments, anti-VEGF injections are currently the most common and most effective for wet AMD.

Anti-VEGF injections are one of the most effective ways to reduce and sometimes reverse vision loss from wet AMD.

An ophthalmologist administers these injections to each affected eye regularly, usually every 4 weeks.

Since VEGF is beneficial in other areas of the body, anti-VEGF medication must go only in your eye and nowhere else.

For this reason, your doctor will use an injection to place the medication directly into your vitreous cavity. This is the fluid-filled space in your eye between your lens and retina.

What’s in the injection?

Several different injections are typically recommended for the treatment of wet AMD.

Each injection contains a different anti-VEGF medication in a sterile solution, in addition to other ingredients that help the injection work.

In each case, aptamers — chemically synthesized short strands of RNA (nucleic acid) — prevent the VEGF from binding to its receptor.

There are currently five types of anti-VEGF injections used to treat wet AMD:

  • aflibercept (Eylea)
  • bevacizumab (Avastin)
  • brolucizumab (Beovu)
  • ranibizumab (Lucentis)
  • faricimab (Vabysmo)

How the injections work

VEGF travels in your blood. It interacts with receptor sites in the lining of blood vessels, called the endothelium.

The purpose of VEGF is to increase the permeability (leakiness) of blood vessels and help grow new ones. The growth of new blood vessels is important in situations such as wound healing.

In your eyes, however, too much blood vessel growth and vessel permeability can cause wet AMD.

When anti-VEGF medication is injected into your eyes, its binding action prevents VEGF from interacting with endothelial receptor sites. This stops or slows the blood vessel leaking and extra vessel growth in wet AMD.

What to expect during treatment

The injections take place in your doctor’s office.

Your doctor will use numbing drops to ensure that you don’t feel pain and will clean the surface of your eye. They’ll use a device to hold your eyelids open and a thin needle to perform the injection.

During the injection, you may feel a small amount of pressure or discomfort. You might even experience a visual disturbance as the injected fluid mixes with the fluid in your eye.

What to expect following treatment

After your treatment, your doctor will examine your eye and clean the area around it. You’ll receive instructions for follow-up care, such as the use of antibiotic eye drops and acetaminophen (Tylenol) or ibuprofen (Advil) for pain relief.

You may experience a small amount of:

  • blurred vision
  • floaters
  • soreness

However, these symptoms should be mild and disappear in 1 or 2 days.

Plan to have someone drive you home from your procedure. It’s best to wait for at least a day after your injection before you resume driving yourself.

The side effects from anti-VEGF injections are more commonly caused by the injection procedure than the drugs used.

Possible side effects include:

  • a small bleed at the injection site
  • blurred vision
  • eye pain or redness
  • feeling like something is in your eye
  • floaters
  • increased pressure inside the eye
  • infection
  • sensitivity to light

Severe complications, such as retinal tear or detachment, are rare.

Talk with your doctor about which signs and symptoms warrant a call for prompt follow-up treatment.

Anti-VEGF treatments are highly successful in preventing wet AMD vision loss. As a result of these injections, up to 90 percent of people experience vision stabilization, according to a 2018 literature review.

If doctors catch wet AMD early enough, as many as 30 percent of people may regain some lost vision.

The current costs for 1 year of ranibizumab (Lucentis), aflibercept (Eylea), and bevacizumab (Avastin) are $22,960, $25,718, and $4,285, respectively. Faricimab (Vabysmo) typically than ranibizumab (Lucentis) and aflibercept (Eylea).

Eylea, Lucentis, and Beovu have FDA approval for use in the eye, and the treatment cost reflects this expensive clearance process.

Avastin is less expensive because it has FDA approval for the treatment of colon cancer and is used off-label for the treatment of wet AMD.

Ask your doctor’s office for current price information and Medicare coverage status.

Here are some frequently asked questions about anti-VEGF injections.

How successful are anti-VEGF injections?

Anti-VEGF treatments are highly successful — up to 90 percent of people experience vision stabilization after the procedure.

How fast does anti-VEGF work?

Healthcare professionals usually give the injection once per month to start. Eventually, they may reduce the dosage frequency as your vision improves. This may take a few months, but the timeframe will vary among individuals.

Wet AMD occurs due to excessive blood vessel growth under the macula of your retina. These vessels leak fluid that obstructs your vision.

VEGF triggers the growth and leakage of extra blood vessels. Scientists developed anti-VEGF medication to block this growth factor, and healthcare professionals deliver the medication directly into your eyes by injection.

Untreated wet AMD is a leading cause of age-related blindness. Anti-VEGF injections may stabilize up to 90 percent of cases and sometimes reverse vision loss.