Macular degeneration is a common eye disease that causes vision loss in the center of the visual field due to damage to the macula, which is part of the retina. The macula is important for sharp, straight-ahead vision used for reading, driving, recognizing faces and colors, and other detailed tasks. There are two main types of macular degeneration: dry and wet. Dry macular degeneration develops slowly and causes vision to blur over time as light-sensing cells in the macula break down. Wet macular degeneration is more severe and develops when abnormal blood vessels grow under the retina and macula. These vessels can leak blood and fluid, causing rapid damage to the macula.
Eye injections are a common treatment for wet macular degeneration. The injections deliver medication directly into the eye to help prevent further vision loss or even improve vision. Some key questions around eye injections for macular degeneration include:
What medications are used in the injections?
The main medications used for eye injections to treat wet macular degeneration are:
– Anti-VEGF drugs: These drugs block a protein called vascular endothelial growth factor (VEGF) that causes abnormal blood vessels to grow under the retina. The anti-VEGF drugs help shrink these vessels and prevent further leakage and bleeding. The most common anti-VEGF drugs used are aflibercept (Eylea), ranibizumab (Lucentis), and bevacizumab (Avastin).
– Steroids: Steroid eye injections can help reduce inflammation that may occur with macular degeneration. The drug triamcinolone acetonide (Triesence) is commonly used.
How are the eye injections performed?
The eye injection procedure is typically performed in the doctor’s office and follows these steps:
1. Numbing eye drops are applied to the eye to reduce discomfort.
2. The eye and eyelids are cleaned thoroughly to prevent infection.
3. An eyelid holder is used to keep the eye open during the injection.
4. The eye doctor uses a very fine needle to inject the medication into the white part of the eye, which allows it to penetrate to the retina and macula at the back of the eye.
5. After the injection, antibiotic drops may be applied to the eye to prevent infection.
6. The entire procedure usually takes about 5-10 minutes.
How often are the injections needed?
Initially, patients may need eye injections as often as monthly. The goal is to find the longest interval between injections that still adequately controls the disease. Over time, the injection frequency can be reduced to every 4-8 weeks for many patients. However, some may still need injections as often as monthly to maintain vision.
The injection schedule varies based on factors like:
– How the patient responds to treatment
– If there is any recurrence of fluid leakage
– The type of medication used
Regular eye exams allow the doctor to monitor the condition and determine the appropriate injection frequency. If vision worsens in between visits, prompt treatment is needed.
What are the potential side effects?
The majority of patients tolerate the eye injections well with minimal side effects. Potential side effects may include:
– Mild pain or irritation after injection
– Redness in the white of the eye
– Increased eye pressure
– Blurred vision, often temporary
– Risk of eye infection (endophthalmitis), but this is very rare
Serious complications are uncommon. Your ophthalmologist can discuss the specific risks and benefits of the medications used.
What is the evidence that the injections are effective?
Many clinical studies have demonstrated the effectiveness of anti-VEGF eye injections for preserving vision in wet macular degeneration. Some major findings on the benefits include:
– In pivotal clinical trials of ranibizumab (Lucentis), 95% of patients maintained vision at 1 year compared to untreated patients in which only 62% maintained vision.
– In trials of aflibercept (Eylea), approximately 30-40% of patients had noticeable visual improvement after 1 year of treatment.
– Patients receiving frequent anti-VEGF injections are able to maintain adequate reading vision for an average of over 5 years.
– Anti-VEGF injections prevent further vision decline in 90-95% of patients compared to 50% with laser treatment alone.
– Patients beginning anti-VEGF treatment promptly after diagnosis have better long-term outcomes.
Clinical evidence clearly shows that consistent, ongoing treatment with anti-VEGF medications slows vision loss and frequently improves vision in wet macular degeneration. Patients should discuss all treatment options with their ophthalmologist.
Are there any alternatives to the injections?
The main alternatives to anti-VEGF eye injections for wet macular degeneration include:
– Laser surgery – Laser treatment can help control abnormal blood vessels and prevent more leakage. However, many patients eventually still require eye injections to fully control the condition.
– Photodynamic laser therapy – This combines laser treatment with an injected photosensitizing agent. It may be an option for some small areas of leaky vessels.
– Medicated eye drops – An anti-VEGF drug called brolucizumab is FDA-approved for use as an eye drop to treat wet macular degeneration. This provides an alternative to injections for some patients.
– Do nothing – Without treatment, wet macular degeneration typically progresses quite rapidly. Not receiving eye injections would likely lead to significant vision loss.
For most patients, anti-VEGF eye injections remain the most effective option for preserving central vision affected by wet macular degeneration. But discussing all pros and cons with an eye doctor is important.
What can patients expect with ongoing treatment?
With prompt anti-VEGF treatment and consistent eye injections as recommended by their doctor, patients with wet macular degeneration can expect:
– Stabilization of vision in the vast majority of patients
– Possible significant visual improvement in 30-40% of patients
– Ability to maintain good reading and functioning vision over several years
– Reduced risk of legal blindness from the condition
– Ability to extend the time between treatments for many patients
– Preservation of independence for daily activities like reading, driving, hobbies, and recognizing faces
Of course, individual responses vary. Working closely with the ophthalmologist is key to successfully managing wet macular degeneration with eye injections.
Conclusion
Eye injections of anti-VEGF medications are the most effective proven treatment for wet macular degeneration. When administered properly at regular intervals guided by an eye doctor, these injections can stabilize vision and even restore lost vision in many cases. Eye injections cannot fully cure the condition but are invaluable at controlling it long-term. Most patients tolerate the injections well. While eye injections may be inconvenient, consistent treatment is vital to prevent severe vision loss from macular degeneration that can significantly affect quality of life. Patients with wet macular degeneration should have thorough conversations with their ophthalmologist regarding the expectations, administration, time commitment, and outcomes associated with anti-VEGF eye injections.