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Intravitreal injections for Age Related Macular Degeneration

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Until mid-2006 the two main treatments available for wet AMD were laser and photodynamic therapy (PDT). Both were aimed at preventing worsening of vision, but didn’t often succeed and certainly only rarely resulted in improvement of vision.

With intravitreal injections for AMD, It is now possible to prevent worsening of vision in nearly 95% of patients and improve vision significantly in up to 40%. Unfortunately, this AMD treatment is not a cure – it simply suppresses the problem for a short period of time. As a result, many patients now have treatment on a monthly basis. At present, until an alternative treatment for macular degeneration becomes available, these macular degeneration injections are a lifelong ongoing treatment.

What Types Of Drugs Are Used?

The abnormal blood vessels (CNV) in “wet” macular degeneration leak because of a chemical (VEGF) that is naturally present in the retina but in greater quantities in AMD; the drugs that are used block the action of VEGF. When injected into the eye, these anti-VEGF injections reduce the leakage of the abnormal vessels and this can result in stabilised or even improved vision.

There a number of readily available drugs that are used to treat the abnormal blood vessels in AMD; the choice should be discussed with your retinal specialist, and are mentioned in anti-VEGF page. If you’re seen by Dr Chauhan, he will explain the reason for choosing one AMD treatment drug over another.

 

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Anti-VEGF intravitreal injections

How Are The Macular Degeneration Injections Given?

The intravitreal injection (injection straight into the vitreous of the eye) is given in a clean environment in order to reduce the risk of infection. Most patients are concerned about 4 issues:

Will it hurt?

No, intravitreal injections for AMD will not cause any pain. You will have anaesthetic drops instilled into your eye usually about 3-4 times, 5-10 minutes apart by a nurse or orthoptist. At this stage, your eye would already be numb enough for a cataract operation. The injection itself is extremely quick and you will feel a sudden and split-second feeling of pressure. Almost every patient has a “is that all there is to it?” response after their first macular degeneration injection.

How Will I Keep My Eye Open?

Your eye will be held open gently with the gloved fingers of the injecting doctor.

How Will I Keep My Eye Still For The Injection?

You will be asked to look at a particular point on the ceiling. This will keep your eye still.

Will I Be Able To See The Needle?

No. The injection is done from the side and you will not see it at all.

The nurses will test your vision immediately after the injection and will then apply ointment and an eye pad. You may then go home, usually about an hour and a half after entering the clinic. The eye pad should stay on, untouched, for 4 to 6 hours and should then be removed at home. You should then put the gel that you’re given in your injected eye every 1 to 2 hours until you go to sleep. When you wake up the next day, your eye should be comfortable.

You will be provided with the gel before you leave. You will also be given instructions, a list of potential macular degeneration injections side effects, and several contact telephone numbers in case of any problems caused by the macular degeneration treatment.

 

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How Often Do I Need To Have These Intravitreal Injections For Amd?

How frequently these injections are required is variable, and each individual (and even eye) can respond differently to the treatment.

There are a number of signs that wet AMD is present and active, and these include bleeding as well as fluid leakage resulting in swelling of the macula. The aim of the injection treatment is to reduce and control these signs to prevent further damage to the macula, and in a large proportion of patients there is significant improvement in vision.

Injections are initially given on a monthly basis in conjunction with OCT scanning to monitor these signs of active wet AMD. In most patients, these signs completely resolve after a number of macular degeneration injections. At this stage, the time between each AMD treatment is lengthened two weeks at a time as to determine how long these injections last for each individual patient. As long as these signs of wet AMD do not reappear, the time between injections continues to be lengthened progressively to a maximum of twelve weeks (e.g. 4,6,8,10,12 weeks). OCT scanning is done on each visit to closely monitor the macula.

If the scan of the macula at any visit shows signs of active wet AMD again (e.g. swelling of the macula), the time between injections is reduced to an interval where the macula looked stable (no signs of active wet AMD). These injections are then given at this interval on an ongoing basis to control the wet AMD, preventing damage to the macula and further vision loss.

For some patients, there is reduced (but persistent) swelling of the macula with treatment at a four weekly interval, whilst others have signs of active wet AMD at a six weekly interval (requiring the frequency of the injection to be increased to four-weekly intervals). For these patients, there is the option of trying another type of intravitreal injection for AMD to see if it lasts longer (or controls the wet AMD better). Dr Chauhan can best guide which is the most appropriate type of treatment in these situations.

Signs Of Wet Amd With Oct Scanning

AMD with fluid

 

 

 

This is a macular scan of a patient with wet AMD. The dark patches are leakages of fluid within and underneath the macula, which has caused swelling and disturbance to the central vision.

 

 

 

AMD resolved fluid

 

 

 

This is a scan of the same patient following a number of macular degeneration injections. The fluid has completely resolved, meaning that we can attempt to reduce the frequency of treatment.
 

Will I Experience Any Macular Degeneration Injections Side Effects?

While side effects are uncommon with intravitreal injections, they can occur. Some are related to the injection itself while other side effects from macular degeneration injections occur due to the drug. Potential side effects include:

  • Redness and swelling
  • Increased sensitivity to light
  • Blurred vision
  • Dry eyes
  • Watery or itchy eyes

What Are The Risks Of Intravitreal Injections?

Before you receive treatment for macular degeneration, you need to know the risks and benefits so you can make an informed decision.

Chances of injection-related risks:

  • Infection: less than 1/2000*
  • Severe bleeding into the eye: less than 1/1000*
  • Retinal detachment: less than 1/1000*
  • Persistent high pressure in the eye: less than 1/100*
  • Cataract: less than 1/1000*
  • Allergy: less than 1/1000*
  • Inflammation: less than 1/1000* (* for each injection)

Intravitreal drug-related risks:

As is true for any new drug, unknown and potentially serious or life-threatening side effects could occur with anti-VEGF injections. There are two such drugs readily available for macular degeneration treatment. While these should both be discussed with your retinal specialist, it is the opinion of most retinal specialists that the two drugs appear to be equally effective and safe.