Intravitreal injection of medications is standard of care for almost all patients with wet AMD. The treatment is safe. The risk of infection is about 1 in 5,000. The treatments are effective with only 5 percent of patients developing progressive vision loss (as opposed to about 80 percent without treatment). Also, most patients have some visual improvement with treatment. There are two downsides to treatment with medications. One is that the treatments need to be injected into the vitreous cavity with a small needle. With proper anesthesia, most patients have little or no discomfort with injection therapy. The second downside to therapy is that one treatment is not curative. The medication wears off. Most patients require monthly treatments initially and then many patients can decrease treatment frequency. In general, the longer someone has been treated, the less often the treatments are necessary. Most retina specialists tailor therapy to the patient after the initial treatment period by spacing out visits and testing the eye to see how it does at different treatment intervals.
Fequently Asked Question about Intravitreal Injections
A growth factor is a naturally occurring protein that stimulates cell growth, wound healing, and changes in cellular structure. Vascular endothelial growth factor, pictured with this text, is important in the wet macular degeneration. Several retinal diseases cause release of excessive growth factors into the eye. These growth factors can damage the retina and cause vision loss. Intraocular injections of a medication to block the effect of these growth factors are used to treat several retinal diseases. These treatments work in two ways, they stop abnormal blood vessels from growing in the eye and they stop normal and abnormal blood vessels from leaking in the eye.
There are several medications used to treat retinal diseases that block the effect of growth factors. Most of these medications block vascular endothelial growth factor (VEGF). These are called anti-VEFG agents. They include drugs like Avastin, Lucentis, Eylea, and Vabysmo. Eylea and Vabysmo block an additional growth factor. Eylea also blocks placental growth factor and Vabysmo also blocks angiopoietin 2. The medications listed below are in reverse order of FDA approval (newest medications on top).
In 2023, a breakthrough in the treatment of wet macular degeneration was achieved with the FDA approval of high-dose Eylea (aflibercept). Standard Eylea dosages typically consist of 2 mg, but this new high-dose variant delivers 8 mg, setting it apart in terms of efficacy. The primary advantage of the high-dose Eylea is its extended duration of action. Clinical studies have shown remarkable results, with 80 percent of patients responding well to treatments administered every four months. The treatment protocol usually begins with monthly doses, and as the patient progresses, a “treat and extend” approach is often adopted, offering a more convenient and patient-friendly regimen. This milestone signifies a significant advancement in the management of macular degeneration, providing new hope and improved quality of life for those affected by this condition.
Vabysmo, a novel therapeutic agent for macular degeneration, gained FDA approval in 2022 and has shown considerable promise for individuals afflicted with this debilitating eye condition. It distinguishes itself from conventional treatments by its unique mechanism of action. Vabysmo is a bispecific drug, adept at targeting two distinct growth factors that play pivotal roles in the development of abnormal blood vessels and inflammation within the macula, a region crucial for central vision. By effectively inhibiting these growth factors, Vabysmo curbs the pathological processes responsible for macular degeneration, while minimizing collateral damage to healthy ocular tissues. The discerning advantage of this approach lies in the potential for reduced side effects and improved therapeutic outcomes, affording patients the opportunity to preserve and enhance their vision quality and overall quality of life. In studies, Vabysmo shows promise at offering a treatment that lasts longer then it’s predecessors, Lucentis and Eylea.
Eylea, a revolutionary medication, was granted FDA approval in 2011 and has since become a pivotal component in the treatment of various retinal disorders, particularly wet macular degeneration. This therapeutic agent operates by inhibiting the activity of VEGF (Vascular Endothelial Growth Factor), a key factor behind the formation of abnormal blood vessels in the eye. It also inhibits placental growth factor which may explain why, in some patients, it has superior efficacy to Avastin and Lucentis. By targeting VEGF, Eylea effectively halts the progression of these vessels, reducing the risk of vision loss. Eylea is typically administered through intravitreal injections, with an initial phase of frequent monthly treatments, followed by a transition to a “treat and extend” regimen, where the intervals between injections are gradually extended based on individual patient response. This approach ensures that patients receive tailored, efficient care while minimizing the frequency of injections, ultimately improving their quality of life and visual outcomes..
Lucentis is a medication that is used to treat wet age-related macular degeneration. It reduced the risk of vision loss from wet AMD from about 70 percent down to about 5 percent. The treatment improves about 90 percent of patients vision some and about 40 percent of patients vision a lot. It is safe and effective. The risk of harm is low, with about a 1 in 5,000 risk of infection. The bad thing about Lucentis is that it has to be given monthly to be effective, at least initially. The other bad thing is that it is an injection into the eye. With proper anesthesia, the injection rarely hurts.
Lucentis was the first FDA approved anti-VEGF agent specifically developed for wet AMD. It has been in widespread use since 2006. In addition, because of its chemical structure, it has the least effect on systemic VEGF levels.
As of 2023, with the approval of several newer medications for the treatment of wet AMD, the use of Lucentis in most practices has declined.
Avastin is an eye-injected medication used to manage wet AMD (Age-Related Macular Degeneration). Extensive research has demonstrated its comparable efficacy to more costly treatments in preserving and enhancing vision for wet AMD patients. Although Avastin originally received FDA approval for intravenous cancer treatment, it operates by obstructing VEGF, a mechanism adapted for its ocular use in wet AMD treatment. While not officially FDA-approved for ocular application, numerous studies confirm its safety and effectiveness. Although slightly less potent than Lucentis and Eylea, Avastin stands out for its cost-effectiveness and widespread utilization as the most prevalent treatment for wet AMD in the United States.