Expert

Anti-VEGF Treatments for Wet Age-Related Macular Degeneration

Scheie Eye Institute, University of Pennsylvania
A doctor holding a vial of anti-VEGF medication for the treatment of wet macular degeneration.
Learn what anti-VEGF treatments are and how they are used to manage the wet form of age-related macular degeneration.

People with wet AMD can lose central vision from abnormal blood vessels that grow into the retina. These vessels leak fluid into the retina, causing it to become “wet.” In the short term, this causes painless, reversible distortion or gray-appearing areas in the central vision. If untreated, within few days to weeks, the retina is permanently damaged by the abnormal vessels, fluid, and associated scar tissue, and loss of central vision becomes permanent.

Treatment for Wet AMD

Fortunately, years of intensive research revealed that the retinas of some people with AMD secrete too much of a protein called vascular endothelial growth factor (VEGF), causing the growth and leakage of the blood vessels. This process can be slowed or stopped by injecting drugs into the eye that bind and inhibit VEGF.

Currently, three drugs are used to treat wet AMD: Eylea®, Lucentis®, and Avastin®. For most people, they need to be injected into the eye every four to eight weeks, with the frequency depending on each person’s response. The response is measured using an optical coherence tomography retinal imager, which generates a picture of the retina in less than a minute showing the amount of fluid in the retina.

Each of the three drugs can reduce or eliminate the fluid in most people. Eylea’s effect may last a bit longer than the others. Avastin is the least expensive, because it is purchased in bulk for “off-label” use, but was shown to have similar efficacy and safety compared to Lucentis in a large clinical trial sponsored by the National Institutes of Health (NIH) and coordinated by the University of Pennsylvania, called the “CATT” trial.

The Eye Injection

While the concept of having a drug injected into the eye sounds awful, most people find that it’s not as bad as they originally thought. Numbing medicine is put on the eye, which is carefully cleaned before the injection. The injection itself takes only a few seconds. Many people will feel some eye irritation for about a day, mainly caused by the iodine that’s used to sterilize the eye. The use of iodine is important to decrease the risk of infection. The injections have a good safety record, with a 1 in 1000 chance of infection or retinal detachment. Either of these complications needs to be treated immediately.  Infection usually causes severe eye pain and can be treated by injecting antibiotics into the eye. Retinal detachment causes a few seconds of flashing lights in the peripheral vision followed by new “floaters” and then a “curtain” blocking part of the visual field. It requires surgery to re-attach the retina.

New Treatments on the Horizon for Wet AMD

New treatments are being tested that should reduce the frequency of anti-VEGF injections. Brolucizumab has completed clinical trials showing that, after three monthly injections, it can be injected once every three months. It is currently being reviewed by the FDA, so it could become available soon.

In addition, the port delivery system (PDS) is a device implanted into the wall of the eye in the operating room that can store, and slowly release, Lucentis.  This method should result in fewer office visits and treatments. Once the PDS runs out of Lucentis, it can be refilled during an office visit. The device is in phase III clinical trials. Abicipar is another drug that is injected into the eye to target VEGF. It can last as long as 12 weeks, but may have higher rates of eye inflammation than the other anti-VEGF drugs.

RGX-314 is an anti-VEGF treatment delivered by gene therapy.  It has the potential to block VEGF for years following a surgical procedure in which a harmless virus, called adeno-associated virus (AAV), carrying the anti-VEGF gene, is injected under the retina. This approach is more promising now that retinal AAV gene therapy has been approved by the FDA for another disease called Leber’s congenital amaurosis. Results from early clinical trials look promising for safety and efficacy.

Summary

As research to develop more effective and longer lasting treatments for wet AMD continues, comfort during treatment and vision protection should improve.

Resources:

This content was first posted on: July 2, 2019

The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for personalized advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product, therapy, or resources mentioned or listed in this article. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.

These articles do not imply an endorsement of BrightFocus by the author or their institution, nor do they imply an endorsement of the institution or author by BrightFocus.

Some of the content may be adapted from other sources, which will be clearly identified within the article.

More Like This

  • Medical illustration showing a drusen deposit in the retina. Illustration by Bob Morreale, provide courtesy of BrightFocus Foundation.
    Expert

    What Causes Macular Drusen?

    Drusen is a German word meaning “geode.” Since they are the defining feature of age-related macular degeneration (AMD), it’s important to understand what causes them to form. Understanding these mechanisms may lead to treatments that decrease the risk of disease progression.

    July 29, 2019
  • A diagram of chromosome 22 showing the location of the TIMP3 gene, which is associated with Sorsby's fundus dystrophy
    Expert

    Sorsby’s Fundus Dystrophy

    Learn about the diagnosis and treatment of a rare form of inherited retinal degeneration, called Sorsby’s fundus dystrophy, which can appear similar to age-related macular degeneration (AMD), especially in its early stages.

    June 2, 2019
Don't miss out.
Receive research updates, inspiring stories, and expert advice
Keep me informed about: *
Please select at least one.
You must select at least one disease category.
Please enter your first name.
Please enter your last name.