Tailored Anti-VEGF Therapy: Understanding eye injections for exudative retinal diseases and pursuing best practice for you
- sakai208
- Jun 3
- 7 min read
Updated: Sep 24
Summary
For patients who suffer from exudative retinal diseases, such as age-related macular degeneration, diabetic macular edema, retinal vein occlusion, and myopic choroidal neovascularization.
Anti-VEGF therapy is an established treatment. As second-generation drugs emerge, collaborating with experts to update your treatment strategy—including drug selection and injection interval—will lead to better outcomes.
Please contact us to see experts.
Introduction
Imagine looking at the world, and the center of your vision—where you see details, faces, and read—starts to blur, distort, or fade away. This is a reality for millions affected by conditions like Age-related Macular Degeneration (AMD), Diabetic Macular Edema (DME), Retinal Vein Occlusion (RVO), and myopic choroidal neovascularization (mCNV). These conditions, often called "exudative retinal diseases," share a common culprit: abnormal blood vessels and fluid leakage in the macula, the most crucial part of your retina responsible for sharp, central vision.
While these diagnoses can be unsettling, there's significant hope and a highly effective treatment that has revolutionized the way we manage these conditions: Anti-VEGF therapy. You might have heard of it as "eye injections," and while the idea of an injection in the eye might sound daunting, this treatment has saved and improved the vision of countless individuals.
This comprehensive guide is designed to provide you with a clear, general understanding of anti-VEGF therapy. We'll explore what it is, why it's necessary, how it works, what to expect during treatment, and answer common questions to help you feel more comfortable and confident on your journey to protecting your precious sight.
The Problem: Macular Edema and Abnormal Blood Vessels
Before diving into the solution, let's understand the core problem that anti-VEGF therapy addresses.
Your retina is a thin layer of tissue at the back of your eye that senses light and sends images to your brain. At its center is the macula, a small, highly sensitive area responsible for your sharp, central vision, color perception, and ability to see fine details.
In certain eye conditions, a protein called Vascular Endothelial Growth Factor (VEGF) plays a problematic role. While VEGF is essential for normal blood vessel growth and healing in the body, in excess, it can become detrimental to eye health. When too much VEGF is present in the eye, it can:
1. Stimulate the growth of abnormal, fragile new blood vessels: These vessels are often weak and leaky, growing where they shouldn't, particularly in the macula or under the retina. This is a hallmark of "wet" (neovascular) Age-related Macular Degeneration.
2. Increase the permeability of existing blood vessels: Even normal blood vessels can become leaky, allowing fluid and blood to seep out into the surrounding retinal tissue.
When fluid accumulates in the macula due to these leaky vessels, it causes macular edema (swelling of the macula). This swelling distorts the delicate retinal layers, interfering with their ability to function properly, leading to symptoms like:
Blurred or wavy central vision
Distorted straight lines (metamorphopsia)
A blind spot or dark area in central vision
Colors appearing faded
Difficulty reading or recognizing faces
Without treatment, prolonged macular edema and bleeding from abnormal vessels can cause irreversible damage to the macula and severe, permanent vision loss.
Established treatment: Anti-VEGF Therapy
This is where anti-VEGF therapy steps in. As the name suggests, "anti-VEGF" means "against VEGF." These medications are specifically designed to block the effects of the VEGF protein in the eye.
How does Anti-VEGF medication work?
When an anti-VEGF drug is injected into the eye, it acts like a "bouncer" for VEGF. It binds to the excess VEGF protein, preventing it from stimulating the growth of new, leaky blood vessels and reducing the leakage from existing ones. By doing so, anti-VEGF therapy aims to:
1. Reduce or eliminate macular edema: By stopping fluid leakage, the swelling in the macula decreases, allowing the retinal cells to function more normally.
2. Inhibit the growth of abnormal blood vessels: For conditions like wet AMD, it prevents the formation and growth of the harmful new blood vessels (macular neovascularization, MNV) that cause bleeding and scarring.
3. Preserve and often improve vision: By addressing the underlying cause of vision loss, anti-VEGF therapy helps stabilize vision and, in many cases, leads to significant vision improvement.
Conditions Treated with Anti-VEGF Therapy
Anti-VEGF therapy has become the gold standard treatment for several common and serious retinal conditions, including:
1. Wet (Neovascular) Age-Related Macular Degeneration (AMD): This is the leading cause of severe vision loss in people over 50. In wet AMD, abnormal blood vessels (MNV) grow under the macula and leak fluid or blood, causing rapid and severe central vision loss. Anti-VEGF injections are highly effective in stabilizing and often improving vision in wet AMD.
2. Diabetic Macular Edema (DME): A common complication of diabetes, DME occurs when high blood sugar levels damage blood vessels in the retina, causing them to leak fluid and swell the macula. Anti-VEGF therapy helps to reduce this leakage and macular swelling, improving vision for many diabetic patients.
3. Retinal Vein Occlusion (RVO): This condition occurs when a vein in the retina becomes blocked, leading to blood and fluid leakage into the retinal tissue, often causing significant macular edema. Anti-VEGF injections are very effective in reducing the swelling and improving vision after RVO.
4. Other Conditions: In some cases, anti-VEGF therapy may also be used for other less common conditions involving macular edema or abnormal blood vessel growth, such as myopic choroidal neovascularization (mCNV) and certain forms of uveitis, as well as central serous chorioretinopathy.
5. For Your Information: A treatment for dry AMD will be coming soon.
The Medications: What Are They?
Several anti-VEGF medications are commonly used, all administered via eye injection. Your ophthalmologist will choose the most appropriate medication for your specific condition and circumstances. The most common ones include:
Aflibercept (Eylea®): Most commonly used anti-VEGF drug that binds to VEGF for more than 10 years, safely.
High dose-Aflibercept (Eylea®): A second-generation anti-VEGF drug, expected a powerful action, often requiring fewer injections for some conditions.
Faricimab (Vabysmo®): A second-generation anti-VEGF drug, targeting two different pathways (not only VEGF but angiopoietin II) to reduce leakage and abnormal blood vessel growth, potentially allowing for longer treatment intervals.
Brolucizumab (Beovu®): A second-generation anti-VEGF drug, designed to be highly concentrated. It's approved for wet AMD and DME and may allow the exudation dry-up, though it carries a rare risk of inflammation.
Ranibizumab (Lucentis®): One of the traditionally used anti-VEGF drugs specifically approved for the eye.
The Eye Injection (Intravitreal Injection): What to Expect
The idea of an injection into the eye can naturally cause anxiety. However, it's a very common, quick, and generally well-tolerated procedure performed millions of times worldwide. Understanding the process can significantly reduce apprehension.
The injection is performed in a clean, sterile environment, usually in your ophthalmologist's office. Here's a step-by-step overview:
1. Preparation:
You will be asked to lie back comfortably in a treatment chair.
Numbing eye drops will be applied to ensure the procedure is as comfortable as possible. You might feel a slight pressure, but typically no sharp pain.
A small instrument called a speculum may be used to gently hold your eyelids open, preventing you from blinking during the injection.
Your eye will be cleaned thoroughly with an antiseptic solution (often povidone-iodine, which might cause a temporary stinging sensation) to prevent infection.
2. The Injection:
You will be asked to look in a specific direction (e.g., straight ahead or to the side).
The doctor will carefully administer the medication using a very fine needle into the vitreous humor (the jelly-like substance that fills the center of your eye). This is usually done just outside your colored iris, in the white part of your eye.
The injection itself takes only a few seconds.
3. After the Injection:
The speculum will be removed.
You might experience a temporary feeling of pressure or a sensation of something in your eye, and your vision might be a bit blurry or hazy immediately after. This is normal.
The doctor or nurse will often apply an antibiotic drop or ointment to your eye to further reduce the risk of infection.
You may see tiny air bubbles or floaters in your vision, which will typically resolve within a day or two.
You will receive post-injection instructions, which usually include avoiding rubbing your eye and being vigilant for any signs of infection.
Does it hurt? Most patients report feeling little to no pain due to the numbing drops. You might feel a dull pressure or a brief stinging sensation, but sharp pain is rare. Many patients are surprised by how quickly and easily the procedure is completed.
Treatment Schedule and Duration
Anti-VEGF therapy is rarely a one-time treatment. These conditions are chronic, meaning they often require ongoing management.
Initial Phase: Typically, you'll receive a series of injections, often monthly for the first 3 months. This "loading phase" aims to get the disease under control and reduce leakage and abnormal vessel growth. But it depends on the disease activity.
Maintenance Phase: After the initial phase, your doctor will adjust the treatment schedule according to the disease condition. For this judge, expert’s eye is necessary.
Potential Side Effects and Risks
While anti-VEGF injections are generally very safe and effective, like any medical procedure, there are potential side effects and risks. It's important to be aware of them, although serious complications are rare.
Life with Anti-VEGF Therapy: What to Expect in the Long Term
What would be your burdens if not treated?: You will find inconvenience in daily living. For example, you may find difficulty in using cell phone, seeing facial expression of your families and friends, and so on.
Communicate with Your Doctor: Always openly communicate any concerns, new symptoms, or changes in your vision to your eye care team. They are your partners in managing your eye health.
Conclusion: A Brighter Outlook for Retinal Diseases
Anti-VEGF therapy, delivered through eye injections, represents one of the most significant breakthroughs in ophthalmology in recent decades. It has transformed the prognosis for millions of patients with exudative retinal diseases like wet AMD, DME, RVO, and myopic CNV turning what were once leading causes of irreversible blindness into manageable conditions.
While the idea of an eye injection might initially feel daunting, understanding the process, its purpose, and its remarkable effectiveness can empower you. These treatments are a testament to medical advancement, offering a lifeline to preserve and often restore the gift of clear central vision. By working closely with your ophthalmologist, adhering to your treatment schedule, and proactively managing any underlying health conditions, you are taking the most vital steps towards protecting your precious sight for years to come.
This article was reviewed by
Dr. Yoko Ozawa, MD, PhD
Professor, Department of Clinical Regenerative Medicine, Fujita Health University
