Treatment with Intravitreal Injections
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 in about 1 month. Most patients require monthly treatments initially and then many patients can decrease treatment frequency to about every 2 months after a year. Some patients can stop treatment but many cannot. Most retina specialists try to 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
Treatment with Anti-VEGF Medications
A group of proteins in the body, called vascular endothelial growth factor (VEGF), play a significant role in the formation and maintenance of the abnormal blood vessels that damage the retina in wet macular degeneration. These abnormal blood vessels are called choroidal neovascularization (CNV). The anti-VEGF drugs are injected directly into the vitreous. Once inside the eye, the medication diffuses throughout the retina and choroid. It binds strongly to the abnormal VEGF proteins, preventing the proteins from stimulating further unwanted blood vessel growth and leakage. At the time of this being written (January 2014), there are three anti-VEGF drugs currently in widespread use for treatment of wet AMD. Lucentis was the first FDA approved effective anti-VEGF drug available in 2006. Avastin was developed before Lucentis and is used for cancer therapy. It is not FDA approved for use in the eye, but has been shown to be safe and effective in several larger studies for the treatment of wet AMD. Eylea is FDA approved for injection in the eye for treatment of wet AMD. These three medications are each described below.
Treatment with Lucentis (Ranibizumab)
Lucentis ($1950.00 per dose) 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. In addition, Lucentis is very expensive.
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.
Treatment with Eylea (Aflibercept)
Eylea ($1850.00 per dose) is a medication injected into the eye to treat wet AMD. Studies have shown that it is equivalent to Lucentis for maintaining and improving vision. It has a higher binding affinity for VEGF than Lucentis and therefore might be a little stronger than Lucentis. Eylea might need to be given less frequently than Lucentis for wet AMD. A survey in 2014 of retina specialists suggests that most retina specialists in the US think that Eylea is a more effective than Lucentis at clearing subretinal fluid in patients with wet AMD.
Eylea is also expensive but costs a little less than Lucentis. There is a small risk of infection and bleeding with Eylea injections.
Treatment with Avastin (Bevacizumab)
Avastin ($60.00 per dose) is a medication injected into the eye to treat wet AMD. Studies have shown that it is equivalent to Lucentis for maintaining and improving vision. Avastin was FDA approved for intravenous use for treatment of some cancers. It works by blocking VEGF and therefore has been used in the eye for the treatment of wet AMD. Although it is not FDA approved for use in the eye, several studies have shown that it is safe and effective. It is slightly weaker than Lucentis and Eylea. It is a lot less expensive than Lucentis and Eylea and is the most commonly used medication for wet AMD in the United States (Based on the 2014 PAT survey of retinal specialists in the US).