- 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.
Age-related macular degeneration (AMD) is the most common reason for central vision loss in people ages 65 and over.
AMD is caused by changes to the macula. This 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. The macula slowly gets thinner as time passes, and vision gradually gets blurry.
- Wet AMD. Abnormal blood vessels grow under the macula, triggered by too much vascular endothelial growth factor (VEGF). 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.
However, treatment with anti-VEGF injections has been shown to provide stabilization in up to
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 that cause 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: injections of medication to block VEGF
- Photodynamic therapy: the use of light and medication to clot and block targeted blood vessels
- Photocoagulation: the use of 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 at regular intervals, usually every 4 weeks.
Since VEGF is beneficial in other areas of the body, it’s important that anti-VEGF medication 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 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 four types of anti-VEGF injections used to treat wet AMD:
- aflibercept (brand name Eylea)
- bevacizumab (brand name Avastin)
- brolucizumab (brand name Beovu)
- ranibizumab (brand name Lucentis)
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 found 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 use 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
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 from the drugs used.
Possible side effects include:
- a small bleed where the needle has entered
- blurred vision
- eye pain or redness
- feeling like something is in your eye
- increased pressure inside the eye
- sensitivity to light
Severe complications, such as retinal tear or detachment, are rare and happen in only about 0.1 percent of cases.
Talk with your doctor about which signs and symptoms warrant a call for prompt follow-up treatment.
If wet AMD is caught early enough, as many as 30 percent of people may even regain some lost vision.
According to the American Academy of Ophthalmology, as of February 2020, the cost of Beovu, Eylea, and Lucentis was around $1,800 to $2,000 per treatment, while the cost of Avastin was $50 per treatment.
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, as well as Medicare coverage status.
Wet AMD is caused by excessive blood vessel growth under the macula of your retina. These vessels leak fluid that obstructs your vision.
The growth of the extra blood vessels and their leakage are triggered by VEGF. Anti-VEGF medication was developed to block this growth factor and is delivered directly into your eyes by injection.
Untreated wet AMD is responsible for most cases of age-related blindness, but anti-VEGF injections may provide stabilization in up to 90 percent of cases and can sometimes reverse vision loss.