Anti-VEGF treatment is a way to slow vision loss in people who have a condition called “wet” age-related macular degeneration.
Age-related macular degeneration is the leading cause of vision loss in people 50 years or older in the United States. It involves damage to the macula, a small but very important area at the center of the retina. The macula allows you to see fine details clearly. Whenever you read, drive or perform any activity that requires seeing precise details, you are engaging your macula.A person with AMD loses the ability to perceive fine details both up close and at a distance. This loss of vision affects only your central vision, while your peripheral vision remains normal. While 90% of those with AMD have “dry” AMD, the remaining 10% have a more serious condition called exudative or “wet” AMD. Wet AMD occurs when abnormal blood vessels grow underneath the retina. These unhealthy vessels leak blood and fluid, which can scar the macula. For patients with wet AMD, vision loss may be rapid and severe.
How does anti-VEGF slow vision loss?
Researchers who study wet AMD have found that a certain chemical in your body is critical in causing abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor or VEGF. Recently, scientists have developed several new drugs – called anti-VEGF drugs – that can block the trouble causing VEGF. Blocking the VEGF reduces the growth of abnormal blood vessels, slows their leakage and thereby helps to slow vision loss. Approximately one-half of the patients who take anti-VEGF agents for wet AMD experience visual gain in the first year of treatment.
The anti-VEGF drug must be injected into your eye with a very fine needle. Dr. Comaratta will clean your eye to prevent infection and he will administer an anesthetic to your eye to reduce pain. Initial treatment typically involves three sequential anti-VEGF injections usually once per month. At each visit, the patient undergoes diagnostic testing and examination to assess their response to treatment. With successful treatment[resolution of the leakage], the patient will be monitored closely for recurrence of leakage. This will involve daily patient monitoring of an Amsler grid and frequent follow up visits with diagnostic testing and examination. If leakage is persistent after three injections an alternative anti-VEGF agent will be recommended. In most patients Anti-VEGF treatment is not a cure for their condition but a very effective treatment that requires maintenance therapy. The goal of therapy is to maintain the best vision possible with the fewest number of injections.
Risk of Anti-VEGF treatment:
As with any medical procedure, there is a small risk of complications following anti-VEGF treatment. The anti-VEGF drugs themselves have no toxic side effects. The only real risk is a slight chance of infection following the injection. Dr Comaratta will carefully clean your eye prior to the injection to greatly reduce this risk. For most people, though, the tremendous benefit of the treatment outweighs the small risk of infection
Is Anti-VEGF the right treatment for you?
Dr. Comaratta will determine if the treatment is appropriate for you. It is only available as a treatment for those patients with “wet” AMD. In some cases, Dr. Comaratta may recommend combining anti-VEGF treatment with other therapies, depending upon the specific condition of your macular degeneration.
Which Anti-VEGF agent should I have?
The choice of an anti-VEGF agent is a difficult one. All are very safe and very effective. The vast majority of patients will respond equally well to each of the three agents. Avastin and Lucentis have been studied head to head and proven to be equally effective treatment for wet AMD in a large case controlled study performed by the National Institute for Health. Eyelea has shown equal effectiveness but not studied in direct comparison with the other two.
Given the equality in safety and effectiveness, Dr. Comaratta typically recommends starting with Avastin. Patients who present to him already being successfully treated with Lucentis or Eyelea will be continued on these medications.
We are fortunate to have three very effective treatment options. For the patient who does not respond to initial therapy it is reassuring to know there are two additional agents to utilize. The vast majority of patients will respond successfully to at least one of the agents.
Is Anti-VEGF treatment painful?
There is, of course, anxiety regarding the injection itself. With appropriate topical anesthesia, the injection itself is tolerated well by the majority of patients. There is often some discomfort post injection due to the sterilizing solution placed in the eye to prevent infection. Dr. Comaratta recommends aggressive lubrication with artificial tears or ointment to ease any discomfort following the procedure. Patients are encouraged to return to normal activity as soon as they feel comfortable. View an Anti-VEGF injection video.
Is Anti-VEGF treatment used in any other eye conditions?
Yes. Anti-VEGF treatment is now being utilized effectively for the treatment of diabetic retinopathy, and retinal vein occlusion.