The macula is the central region of retina that is responsible for clear central and forward vision. If it becomes blurry or disoriented it could even become dark enough to blind you completely.

Eylea (Aflibercept) and Lucentis (Ranibizumab) are among the most frequently prescribed anti-VEGF agents that can slow macular degeneration progression when administered intraocularly.

Faricimab-svoa is designed to inhibit two disease pathways that contribute to diabetic macular edema and wet age-related macular degeneration, including diabetic macular edema and neovascular macular degeneration.

Anti-VEGF Drug

Vascular Endothelial Growth Factor (VEGF), is a protein which promotes the formation of new blood vessels in diabetic retinopathy patients, leading to abnormalities and diabetic macular edema that compromise vision loss. Anti-VEGF drugs used for macular degeneration treatment help slow new vessel growth while stabilizing retinal blood vessels. These medications can either be delivered directly into the eye via intravitreal injection or taken orally as pills; common anti-VEGF treatments include monoclonal antibodies such as bevacizumab or ranibizumab; as well as small molecules which inhibit tyrosine kinases stimulated by VEGF such as sunitinib, sorafenib, axitinib and pazopanib.

People suffering from wet age-related macular degeneration produce too much VEGF, leading to abnormal blood vessels that leak fluid, swelling the macula in central retinal area called macula, which in turn may blur or distort central vision, impeding activities like reading, driving and face recognition. This condition is known as Neovascular or Wet Age Related Macular Degeneration.

Studies indicate that patients receiving intravitreal anti-VEGF injections can experience stabilization of their visual acuity for up to two years following intravitreal anti-VEGF therapy injections; however, for many others this may take longer. Researchers believe novel therapies such as extended-acting anti-VEGF agents, investigational gene therapies, or other innovative approaches could decrease treatment burden and enhance long-term visual outcomes by decreasing treatment burden of neovascular AMD.

Investigators from UC Berkeley, Baylor College of Medicine and the National Institutes of Health have collaborated to create an implantable device which allows ophthalmologists to deliver an anti-VEGF drug used for macular degeneration injection treatment in microdroplet form directly to retinal tissue over a six month period. Initial implantation and refills can take place during office visits to reduce frequency of injections under current treatment protocols.

Intravitreal Injections

Injections are administered directly into a small space in the back of your eye called the vitreous cavity, filled with jelly-like fluid. Usually performed outpatient and under local anaesthetic and sterile conditions. An injector device used by your ophthalmologist guides injections directly into your eye using an ocular map; depending on your condition and response to medication injections may need to be given every month or less frequently over a one year period.

Anti-vascular endothelial growth factor (anti-VEGF) drugs are among the most widely prescribed treatments for macular degeneration injection. These agents work by blocking a protein which promotes blood vessel formation in the retina and helping reduce fluid build-up underneath it, thus treating macular degeneration more effectively.

One of the most widely prescribed drugs in this category is Aflibercept (Eylea). Aflibercept is a recombinant human fusion protein that acts as a decoy receptor to block activity of proteins belonging to the Vascular Endothelial Growth Factor family of proteins such as VEGF-A and VEGF-B by binding directly to them and inhibiting their activity, making this drug effective against age-related macular degeneration in two similar phase III studies of similar design.

Though medication can be highly effective, it may cause side effects. These include headaches, blurry vision and the appearance of small particles in your eyes (floaters). Any concerns should be discussed with your ophthalmologist; infection risks associated with this form of therapy must be managed quickly – any sign of infection such as decreased vision or redness on the white part of the eye should prompt immediate contact with medical authorities.

Note that vision may take several hours to return to normal after receiving an intravitreal injection, so be sure to plan on having someone drive you home after your appointment or check if your health insurance offers transportation assistance. Also keep in mind that your ophthalmologist may need to dilate the eye prior to injecting which could result in blurred vision lasting up to 6 hours after your visit.

Side Effects

Anti-VEGF injections not only restore vision, but they may also slow further macular degeneration by blocking chemicals that cause the formation of unhealthy blood vessels underneath the retina – which, if left untreated, leads to macular edema resulting in rapid vision deterioration.

Macular Oedema can arise as the result of wet age-related macular degeneration (AMD) or retinal vein occlusion (RVO), caused by leakage of fluid from damaged blood vessels in the retina and leading to fluid build-up within it. If left untreated, this fluid can swell up and cloud central vision, ultimately blurring central vision significantly.

Ranibizumab (Lucentis), an intravitreal anti-VEGF medication, works by blocking the chemical that promotes abnormal blood vessel growth under the retina and can even help slow their leakage.

An injection is given using a thin needle and performed under sterile conditions in a clinic, where a drop of local anaesthetic will be added to help numb and decrease discomfort during injection. After which, a doctor will clean the surface of your eye before placing a small clip called a speculum on it to keep it open during surgery.

Once numbness has taken place, the medication will be injected directly into the vitreous (the clear gel-like substance in the centre of your eyeball). You may then notice dark floaters appearing in your vision due to drug entering your eyeball.

Patients may experience temporary redness and gritty sensation, however this should subside overnight. Treatment usually repeats monthly or less frequently for optimal results and has been proven to improve vision in wet AMD, macular oedema following retinal vein occlusion as well as macular edema due to retinal vein occlusion.

Risks associated with eye injections include infection inside the eye, elevated intraocular pressure and detached retina – as well as blood clots on eyeball lining or elsewhere in body such as lung or brain tissue linings – though your ophthalmologist will assess your individual risks prior to administering an injection.

Precautions

Wet age-related macular degeneration (neovascular AMD) can result in central vision becoming blurry or distorted, due to blood vessels growing under the retina leaking fluid and breaking apart, leading to scaring and damage on its surface and rapid loss of central vision. Therefore, this form of macular degeneration needs prompt treatment in order to halt further loss of sight.

Anti-VEGF injections into the eye may slow progression to wet age-related macular degeneration. According to the AREDS study, this approach reduced progression risk by 27-30% over five years. These injections should be scheduled regularly at intervals of four weeks at our clinics.

This procedure begins by administering eyedrops to numb the eye, followed by placing them under a small springy clip while an extremely thin 30 gauge needle is injected through a tiny hole into the white of their eye through which a very fine 30 gauge needle injects an anesthetic solution via injection. Although short and painless, some patients may notice some visible greasy smears or floaters in their vision after 48 hours, which should fade over time.

An injection is administered every four weeks with a new dose of the medication in order to maintain visual acuity that enables patients to perform daily activities such as driving and reading, such as driving safely or reading books. Initial studies demonstrate the success of this approach in slowing the progression of wet macular degeneration.

Roche Group’s Genentech subsidiary announced that 2-year data from its Vabysmo trial confirmed that faricimab-svoa (Vabysmo) is an effective and safe treatment option for treating wet age-related macular degeneration associated with diabetic macular edema.

Aflibercept is a monoclonal antibody approved by the FDA to block the actions of Vascular Endothelial Growth Factor or VEGF, an encourager of abnormal blood vessel growth in retina. Aflibercept is the only FDA-approved agent approved to reduce wet macular degeneration progression among those diagnosed with Neovascular Age-Related Macular Degeneration.