The most common and effective treatment for wet age-related macular degeneration (wet AMD) is called anti-VEGF therapy. Your doctor gives you this therapy through an injection directly into your eye.
How often you need these injections depends on your case of wet AMD. It could be as often as every few weeks or as far apart as every few months. Here’s what to know about this treatment.
What’s in the Injection
VEGF stands for vascular endothelial growth factor. It’s a protein that promotes the growth of blood vessels when your body needs them.
When you have macular degeneration, some new blood vessel growth isn’t healthy for your eyes. They tend to be weak and grow in places that harm instead of help your vision. Anti-VEGF therapy keeps VEGF from making new blood vessels grow in your eye, which in turn can help curb fluid leakage in your retina.
There are four main kinds of anti-VEGF treatments:
- Aflibercept (Eylea)
- Bevacizumab (Avastin)
- Brolucizumab (Beovu)
- Ranibizumab (Lucentis)
All four medications stop blood vessel growth, though they do it in slightly different ways. They’re similarly effective and come with similar risks. Your doctor will help you decide which is best for you.
The main side effect risks are infection or inflammation in the eye, bleeding into a gel inside your eye called the vitreous gel, and retinal detachment.
Before the Injection
Your eye doctor will confirm you have wet AMD with a dilated eye exam and imaging before you begin treatments. When it’s time for your first treatment, you can get the injection in your doctor’s office during an appointment that usually lasts less than an hour. The procedure itself will take about 15 minutes.
First, your doctor will numb your eye using eye drops. Then she’ll clean your eye with a yellow iodine solution. To keep you from blinking during the injection, your doctor will put a small device on your eye to hold your top and bottom eyelid out of the way.
Getting the Shot
The needle your doctor uses to give you the injection is very small and thin, and the injection happens very quickly, in less than a second.
Your doctor will ask you to look up and then will put the needle into the white part of your eye (the sclera). She’ll insert the needle as far as the vitreous part of your eyeball -- a jelly-like substance in the middle of your eye -- to inject the anti-VEGF.
Usually, the injection is painless. Some people feel a little discomfort or pressure. As the anti-VEGF mixes with the fluid in the middle of your eye, you might see wavy lines.
Once the needle is out, your doctor will put a sterile cotton tip over the injection site for about 10 seconds to put pressure on it and keep fluid from escaping. Then she’ll flush your eye with a solution to lubricate it and keep it from getting irritated.
You may see an improvement in your wet AMD symptoms within a week of your injection. You may be sore for a few days following your injection, and your vision may be slightly foggy. You can take over-the- counter pain relievers such as acetaminophen or ibuprofen to help with the discomfort. Putting a cool washcloth on your eyes for about 10 minutes every half-hour may also help soothe soreness.
If the needle hit a blood vessel in your eye as your doctor injected it, you may have some redness in the whites of your eye for up to 2 weeks. As long as you don’t have pain or vision problems, this is a harmless side effect.
If you have certain side effects after your injection, tell your doctor so you can come in for a check of your eyes. Some symptoms to watch for are:
- Eye pain
- Sensitivity to light
- Vision changes
- More eye pressure
- “Floaters” in your vision
Pain, sensitivity to light, and vision changes could be signs of an infection. These complications are rare, but if you have them or any of the symptoms listed above, you should tell your eye doctor.