Wet age related macular degeneration (ARMD) can result in significant vision loss and requires monthly injections of medications that slow the formation and leakage of abnormal blood vessels.

Drugs are administered via injection using a fine needle for minimal discomfort, while an Amsler grid test can help identify macular degeneration.

Anti-VEGF Injections

Anti-VEGF injections are the go-to therapy for wet AMD. Although anti-VEGF shots can significantly slow vision loss progression, regular treatments are necessary. A recent study suggests that excessive use of these drugs could actually increase risk for another sight-threatening condition — glaucoma.

Researchers conducted an in-depth examination of data on over 800 patients who received multiple intravitreal injections of bevacizumab for exudative AMD between 2009 and 2013. Their examination included looking at both injection rates per year as well as those needing glaucoma surgery during that same time frame; their results were published this month in JAMA Ophthalmology journal. Their researchers discovered that those receiving seven or more injections per year had a 2.5 times increased risk of needing glaucoma surgery than those who received five or fewer injections per year.

According to the National Eye Institute, people who require at least seven anti-VEGF injections annually are at a greater risk for developing glaucoma compared to those receiving less than four injections annually. Overuse of anti-VEGF medications may also increase their chances of retinal hemorrhage and eye floaters.

Multiple factors can determine the lifespan of an anti-VEGF injection, including when and how often treatment begins and is administered. Side effects typically include discomfort, eye pain or floaters which typically subside a few days post injection. An ophthalmologist will inject medication directly into a small opening in your eye through a sterile needle; typically this procedure takes place in doctor offices; however for severe AMD cases this process must occur in an operating room.

At present, the only effective means of stopping progression of neovascular AMD is anti-VEGF injections at regular intervals. Research seeks to reduce this number through personalized OCT-guided dosing and novel delivery methods – for instance faricimab-svoa (Vabysmo) has an indicated dosing interval of 12 weeks and recent research showed that 68% of the neovascular AMD patients who could manage an q12 interval with Aflibercept had similar visual acuity results as those requiring more frequent regimens.

Aflibercept Injections

Eylea, or anti-VEGF injections, are the latest addition to the market and serve to inhibit an enzyme called VEGF (vascular endothelial growth factor) which stimulates new blood vessel formation while simultaneously leading to leakage of existing ones. Aflibercept offers significant therapeutic options for wet age related macular degeneration and diabetic macular edema patients alike.

Aflibercept is a fully human, recombinant fusion protein designed to act as a decoy receptor and block signaling mediated by members of the vascular endothelial growth factor (VEGF) family such as VEGF-A, B, and C without binding to or activating their respective ligands. Two landmark clinical trials – PULSAR in wet AMD and PHOTON in DME – demonstrated non-inferiority to ranibizumab as treatment options; their results were presented at 55th Annual Scientific Session of Retina Society in November 2022.

In the PULSAR study, patients were given Aflibercept every four weeks; for the PHOTON trial it was given monthly for three months before gradually decreasing to once every month after that. Aflibercept is administered as an eye drop that is injected directly into your eye with a needle at your doctor’s office or hospital and cleaned and numbed prior to use in order to minimize discomfort during injection; vision may become temporarily blurry after receiving injection; therefore it is advised that driving or operating machinery remain off during treatment until vision returns back to normal.

Recent EMR database study, performed retrospectively and comparative non-randomized, found that 68% of eyes achieved 12 week dosing intervals within two years of starting treatment with Aflibercept injections for wet age-related macular degeneration patients, showing similar visual acuity outcomes to those requiring more frequent dosing, with no increased risk for adverse events or increased risks associated with adverse events. These results support using an individualised treat-and-extend regimen with Aflibercept for wet AMD. Furthermore, study also included an investigation of patient and physician factors on treatment outcome as well as treatment success analysis of both factors on treatment outcome.

Ranibizumab Injections

Ranibizumab (Lucentis) injections help prevent abnormally growing and leaking blood vessels behind your eye that threaten vision loss. This drug inhibits the action of vascular endothelial growth factor (VEGF), an internal protein produced by your body that promotes the formation of new vessels in retina.

Lucentis injections help slow vision loss and may even improve it in some cases, with three typically required to achieve maximum benefits. Initial discomfort or redness in the eye may occur as well as floating objects around your field of vision; these side effects typically subside within a few days.

Your ophthalmologist will use a small hand-held probe to administer medication into your eye. You will be seated comfortably on a semi-reclined chair and draped to maintain sterile conditions around it. A topical anesthetic will likely be administered prior to beginning, after which pressure in your eye may occur as the medication is injected; you’ll then be monitored for approximately 30 minutes post injection to make sure you remain comfortable during this process.

Recent research revealed that monthly injections of ranibizumab into eyes of individuals suffering from advanced macular degeneration (AMD) significantly slowed progression of macular atrophy compared to a control group. Results of PREVENT, the two-year randomized clinical trial, were recently published in Ophthalmology Retina.

Susvimo (ranibizumab implant) provides an alternative to monthly anti-VEGF eye injections: an implant that delivers 100mg/mL ranibizumab directly into the eye over six months, Genentech reports. Patients receiving Susvimo achieved and maintained visual gains (+0.2 to +0.5 eye chart letters from baseline) more quickly compared with those receiving monthly injections, according to clinical trial data provided by Genentech.

Monthly intravitreal injections of ranibizumab to treat wet AMD are associated with low rates of both ocular and systemic serious adverse events (SAEs), but treatment may take time and cost significantly.

Pegaptanib Injections

Pegaptanib (Macugen) injections help prevent the growth of microblood vessels associated with wet macular degeneration (AMD). These blood vessels leak into the macula, an area in the center of retina that contains highly pigmented retinal tissue, and cause vision loss by blurring or blocking central vision. Made by Eyetech Pharmaceuticals and Pfizer, the drug binds with VEGFR-1 which causes abnormal vessel growth and leakage leading to wet AMD, helping patients maintain visual acuity while slowing progression towards legal blindness.

Pegaptanib, an aptamer designed to target VEGF specifically without interfering with normal cell functions, has been found effective at improving visual acuity for people suffering from wet macular degeneration who had central retinal vein occlusion (CRVO) and macular edema. In two randomized double-masked trials involving patients who had both CRVO as well as either macular edema or showed good response to panretinal photocoagulation therapy. It was given via intravitreous injection every six weeks for 48 weeks in two randomized double-masked trials where patients either had central retinal vein occlusion (CRVO) with central retinal vein occlusion (CRVO), or both central retinal vein occlusion and macular edema.

Both trials revealed that injections of pegaptanib, in conjunction with photocoagulation, significantly improved people with wet AMD’s ability to retain visual acuity and slow macular degeneration’s progression toward severe vision loss or legal blindness, while decreasing laser therapy sessions needed. Furthermore, injections were generally safe and well tolerated with only mild to moderate side effects lasting short term; no permanent damage resulted from their use.

Loss of central vision due to wet macular degeneration can drastically diminish a person’s quality of life, impacting their ability to read, recognize faces, drive and interact with society socially and affect self-esteem and confidence levels. Rapid deterioration may even leave someone unable to live alone and increase stress on caregivers who may increase risk for cardiovascular disease and other medical issues – so early treatment for wet macular degeneration must be implemented swiftly to safeguard patient’s quality of life.