After receiving the inactivated COVID-19 vaccine, one patient experienced macular edema and central retinal vein occlusion in his right eye, thought to be due to inflammation-induced thrombosis and may benefit from anti-inflammatory therapy.

Aflibercept inhibits vascular endothelial growth factor (VEGF), and is used to treat wet age-related macular degeneration and diabetic macular edema. A British court recently upheld NHS’s right to continue prescribing Aflibercept.

Symptoms

A 28-year-old male developed blurry vision 8 hours after receiving his initial dose of inactivated COVID-19 vaccine, leading to diagnosis of ischemic central retinal vein occlusion. Fundus examination revealed dilated and tortuous retinal veins at the posterior pole with hemorrhages and macular edema as well as multiple hypofluorescent spots on fluorescein angiography suggesting retinal vein occlusion; treatment included IVA with Aflibercept with good visual outcomes achieved.

Age-related macular degeneration (AMD) is a progressive condition resulting in gradual loss of central vision due to damage of cells in the macula, the light-sensitive part of retina at the back of eye. Up to 10% of people with AMD progress into wet AMD which causes blindness due to excess blood vessels forming between layers of retina cells. An experimental treatment known as ASP7317 may slow or stop this transition by injecting human stem cells that have been altered into functioning like retinal pigment epithelial (RPE) cells directly into eye.

Diagnosis

At first, symptoms of dry age-related macular degeneration may not be immediately evident. Over time however, central vision will gradually blur or darken and colors may seem less vibrant than expected. A regular dilated eye exam can detect changes to your macula that you might otherwise miss.

Macular degeneration often develops gradually over time as yellow protein deposits known as drusen accumulate under the retina, leading to retinal thinnng and macula dysfunction, eventually leading to blurry or dark areas in your central vision and difficulty driving, reading or recognising faces, colors or geometric shapes.

Macular degeneration comes in two varieties, dry and wet. The former occurs most frequently and results when retinal tissue thins down over time causing small protein clumps to collect under it. While wet form macular degeneration is less prevalent but can have far greater consequences such as developing abnormal blood vessels which leak fluid onto macula scarring it permanently.

Blood-leakage and scarring can rapidly cause severe vision loss if left untreated, but an optometrist can help you stop wet macular degeneration from worsening by providing vitamins and injectable medications to stop abnormal new blood vessel growth and scarring in your macula. Bevacizumab, ranibizumab and pegaptanib have been proven to halt abnormal retinal neovascularization to slow its progress further.

Ocular angiogram is a special test designed to detect abnormal blood vessels that could lead to wet macular degeneration. An orange-red dye injected through your arm vein travels directly to retinal blood vessels where it will show up as bright spots when entering your eyes and allow your doctor to easily identify any new abnormal growths that might have formed beneath the retina. This quick and painless test can be completed right in our office.

Treatments

Gene therapy offers hope in treating wet age-related macular degeneration.

Macular degeneration treatments exist to slow its progress, with most focusing on suppressing vascular endothelial growth factor (VEGF). While they help preserve central vision, these don’t cure the disease and require repeated injections into the eye for their effects to be maintained. A new treatment aims to provide medication through an implantable reservoir instead of monthly injections for increased effectiveness and possibly better visual outcomes.

VABYSMO, a monoclonal antibody targeting VEGF-A and binding to it, inhibits this vascular endothelial growth factor to prevent abnormal blood vessel growth in retina. Available through retina specialists as a prescription-only treatment option, VABYSMO is widely used to treat wet age-related macular degeneration, diabetic macular edema (DME), and central retinal vein occlusion-related macular edema.

A 47-year-old male reported blurred vision 8 hours following his first dose of COVID-19 vaccine. Fundus examination revealed dilated and tortuous retinal veins in the posterior pole as well as retinal hemorrhages, macular edema and multiple hypofluorescent spots suggestive of fluid leakage from blood vessels; fluorescein angiography demonstrated multiple hypofluorescent spots suggesting fluid leakage; this patient was treated successfully using pulse corticosteroid treatments combined with tapering oral steroids without needing intravitreal injection; otherwise he remained healthy.

Moderna’s mRNA-based vaccine for the prevention of psoriasis and macular degeneration is currently undergoing trials with two independent study cohorts that include individuals aged 50-65 years of age, to assess its immunogenicity, safety, and reactogenicity compared with licensed influenza and SAR-CoV-2 vaccines. Moderna plans on seeking initial regulatory approval by 2025.

Diabetes and aging lead to retinopathy

A new report demonstrates low screening rates among diabetes patients and underscores the need for greater oversight. Youth with type 2 compared with type 1 diabetes face nearly double risk for retinopathy and should be tested more frequently; similarly, those who have experienced an ischemic stroke with atrial fibrillation are especially prone to recurrence; thus requiring close monitoring for signs of retinopathy recurrence.

Side Effects

Over 8 million Americans suffer from age-related macular degeneration, a progressive loss of central vision due to damage to cells in the light-sensitive retina. About 10% of cases develop wet macular degeneration characterized by abnormal blood vessels that form between layers of retina that gradually cause swelling and vision loss over time.

Before recently, wet AMD could only be treated using injections of bevacizumab – an anti-vascular endothelial growth factor medication injected using an eye dropper syringe – into the eye via special syringe. Bevacizumab injections were initially provided through National Health Service but in September 2022, a UK court decided that NHS could use ranibizumab instead as treatment option.

This medication works by binding to a protein in the eye that blocks its function, thus inhibiting new blood vessel formation and decreasing their permeability. It is commonly prescribed to treat wet age-related macular degeneration, diabetic macular edema and macular edema after central retinal vein occlusion; worldwide prescriptions of Lucentis are also available for purchase.

A case study published in December 2023 examined 7 patients who experienced uveitis after receiving BNT162b2 vaccine against SARS-CoV-2 virus. According to its authors, timing of complications 5.2 days post vaccination indicates an association; however, causal relationships cannot be ascertained based solely on this observational design.