Which conditions are treated with eye (intravitreal) injections?
Anti-VEGF (vascular endothelial growth factor) injections are commonly used to treat various eye conditions, particularly those involving abnormal blood vessel growth. The most common conditions treated with anti-VEGF injections include:
AMD occurs in two forms
Anti-VEGF injections are a primary treatment for neovascular or wet AMD. These injections help reduce abnormal blood vessel growth in the macula (the part of the eye responsible for sharp vision) with the aim of preserving vision and preventing further damage.
Diabetic macular oedema (DME):
Patients who have diabetes can sometimes have secondary DME as a complication of diabetic retinopathy. This is where fluid accumulates at the macula, leading to vision loss. Anti-VEGF injections can help reduce the swelling and improve vision in some patients with DME.
Retinal vein occlusion (RVO):
When a retinal vein becomes blocked/occluded, anti-VEGF therapy is often employed to treat macular swelling that is caused by central retinal vein occlusions or branch retinal vein occlusions, conditions that result in reduced blood flow in retinal veins.
Pathological myopia:
Myopic choroidal neovascularization, a complication of severe near-sightedness, can be treated with anti-VEGF injections to prevent vision loss.
The aim of treatment is firstly to prevent further loss of vision. Improvement in vision occurs in many patients, but certainly not all. In some patients, vision can worsen despite treatment. It is not known how many injections will be required in the long term, or how frequently the injections need to be given. Three monthly loading Injections are usually required. it is important to realise that this is a course of injections and not a cure. Each patient’s course of treatment is tailored to their specific needs.
What to expect with eye (intravitreal) injections?
Frequency of Injections: Initially, you may receive monthly injections to quickly address the abnormal blood vessel growth in the macula. The frequency may decrease over time based on how well your eye responds to the treatment.
Procedure: The injections are usually performed in an outpatient setting, often in an eye clinic. Anaesthetic drops are given 3-4 times to effectively numb the eye. Sometimes a local injection of anaesthetic is given. An antiseptic solution is given to prevent infection. You will be asked to look in a particular direction to keep your eye still. When the injection is given, minimal discomfort is to be expected (equivalent to having blood taken from your arm). Many people do feel a sudden pressure, and this can catch your breath. The injection is extremely quick and followed by some gel drops.
Duration: The eye injection is relatively quick and takes a few seconds. But your entire appointment may take up to 1.5 hours including vision assessment and scans to track how well your eye is responding to the treatment, and the preparation time.
Potential Discomfort: While the injection itself is generally not painful due to the numbing medication, you may feel some pressure or discomfort during and after the procedure. It is crucial to communicate any discomfort to your healthcare provider. You may be sent home with some lubricating eye gel to relieve some discomfort.
Potential Side Effects: Though rare, there can be complications or side effects, such as infection, increased intraocular pressure, or retinal detachment. Your ophthalmologist will discuss these risks with you before starting the treatment.
Vision Improvement: Many patients experience improvements in vision or stabilization of vision loss after anti-VEGF treatment. However, individual responses can vary, and not everyone will respond in the same way. In some cases, vision may not improve with treatment.
Long-Term Treatment: Wet AMD is a chronic condition, and ongoing treatment may be necessary to maintain the benefits of the injections. Your ophthalmologist will determine the appropriate treatment plan based on your individual response to therapy.
It is crucial to maintain regular follow-up appointments with your eye care professional to monitor your progress and adjust your treatment plan as needed. Additionally, you should communicate any changes in your vision or any concerns about the treatment with your healthcare team.
What are the current anti-VEGF treatment options available to me?
There are a few types of anti-VEGF medication currently available for use in Australia:
Ranibizumab (Lucentis): Lucentis was one of the first anti-VEGF drugs approved for the treatment of neovascular (wet) age-related macular degeneration (AMD). It is designed to block the activity of vascular endothelial growth factor (VEGF), a protein that plays a significant role in the formation of new blood vessels. By inhibiting VEGF, Lucentis helps to reduce the growth of abnormal blood vessels in the retina and leakage, which are characteristic of wet AMD. Lucentis is administered through injections into the eye.
Aflibercept (Eylea): Aflibercept is another anti-VEGF medication used to treat wet AMD. It works by blocking the effects of VEGF-A, as well as other related proteins. Aflibercept is administered via injections into the eye, like Lucentis.
Faricimab (Vabysmo): Vabysmo works by blocking the activity of proteins (known as angiopoietin-2 and vascular endothelial growth factor A) through a dual pathway method. These proteins are known to cause the growth of abnormal blood vessels in the eye that can cause macular swelling and vision loss.
Beovu (brolucizumab): Beovu is a medication used in the treatment of wet AMD. Like other anti-VEGF medications, Beovu helps to stabilise or improve vision in many patients with wet AMS, although individual responses can vary.
It is important to note that the choice of which anti-VEGF medication to use may depend on various factors, including the specific characteristics of your eye condition and your response to the medication. Each of these medications have demonstrated effectiveness in slowing the progression of wet AMD and improving or stabilizing vision in many patients.
The treatment regimen often involves an initial series of monthly injections, followed by a maintenance phase where the frequency of injections may be adjusted based on the patient’s response. It is essential for individuals undergoing anti-VEGF treatment to adhere to their ophthalmologist’s recommendations and attend regular follow-up appointments to monitor the progress of the condition and make any necessary adjustments to the treatment plan.
Ozurdex (dexamethasone implant) is a steroid implant injected into the eye, where it releases dexamethasone over time slowly inside the eye, for up to 6 months. Ozurdex is used in treating macular oedema in conditions such as retinal vein occlusion, diabetes and non–infectious posterior uveitis.
How long do eye injections take to work?
The time it takes for eye injections to take effect can vary depending on the specific medication being administered and the underlying eye condition being treated.
In some cases, patients may experience improvement relatively quickly, within days or weeks after the injection. However, it is important to note that the full benefits of the treatment may take some time to take effect, and multiple injections may be needed to achieve and maintain the desired therapeutic effect.
Your ophthalmologist overseeing the treatment will monitor your progress and determine the appropriate schedule for subsequent injections. It is crucial for patients to attend follow-up appointments as scheduled to ensure that the treatment is working effectively and to make any necessary adjustments to the treatment plan.
If you have specific concerns or questions about the timing and effectiveness of eye injections in your case, it is recommended to discuss them with your eye care professional. We can provide personalized information based on your medical history and the details of your treatment plan.
How do I prepare for eye injections?
Understand the Procedure: Familiarize yourself with the details of the eye injection procedure. Ask your healthcare provider any questions you may have about the process, potential side effects, and what to expect prior to treatment.
Discuss Medications: Inform your eye specialist about any medications you are currently taking, including over-the-counter drugs and supplements. They will advise you on whether any adjustments need to be made.
Arrange Transportation: Since your vision may be temporarily affected after the injection, it is recommended that you arrange for someone to drive you home after the procedure. Alternatively, you can use public transportation or ask one of our friendly staff to arrange a taxi after your procedure.
Bring a Companion: Having a friend or family member accompany you to the appointment can provide emotional support and assistance, especially if you need someone to help you get home.
Relaxation Techniques: If you are feeling anxious about the procedure, consider practicing relaxation techniques such as deep breathing or meditation beforehand. Inform our friendly staff about any concerns you may have.
Notify About Allergies: Inform your eye specialist about any allergies you have, particularly if you’ve had a reaction to a previous injection, anaesthetic, or any related medications.
Ask Questions: If you have any concerns or questions about the procedure, please do not hesitate to ask our friendly team of eye specialists or orthoptists. They can provide information to help ease any uncertainties you may have.
What is the success rate of eye injections?
The success rate of eye injections can vary depending on the specific condition being treated and individual patient factors. Eye injections, particularly those involving anti-VEGF medications, are commonly used to treat conditions such as age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO). Here are some considerations:
Age-Related Macular Degeneration (AMD):
The success rate of anti-VEGF injections in treating neovascular or wet AMD is often measured in terms of preventing further vision loss and, in some cases, improving vision. Many patients experience a significant stabilization of their vision, and some may see improvement.
Diabetic Macular Edema (DME):
Anti-VEGF injections are commonly used to reduce swelling in the macula, improving vision and preventing further vision loss. Success may be measured in terms of reduced macular thickness and improved visual acuity.
Retinal Vein Occlusion (RVO):
Anti-VEGF injections are used to treat macular oedema associated with RVO, aiming to reduce swelling and improve vision. Success is often measured in terms of improved visual acuity and reduced macular oedema.
It’s important to note that success rates can vary among individuals, and the response to treatment may depend on factors such as the severity of the condition, the duration of treatment, and the patient’s overall health.
Additionally, success may be defined not only by improvements in vision but also by the prevention of further vision loss and the stabilization of the underlying condition.
Before starting any treatment, it is crucial to discuss the potential benefits and risks with your eye care professional. We can provide personalised information based on your specific diagnosis and circumstances. Regular follow-up appointments are necessary to monitor progress and adjust the treatment plan as needed.
What are the risks with intravitreal injections?
As with any medical procedure, there is a small risk of complications following intravitreal injection. Most complications that might occur are from the injection itself, rather than the drug. For most patients, the benefit of the treatment outweighs the small risk of injection injury.
The following are the major potential risks and side effects of intravitreal injections, but this is not a complete list of all risks. These risks are all rare. Significant loss of vision due to this treatment is very uncommon.
- Serious eye infection (one in 1,500 cases)
- Detached retina
- Increase in eye pressure and glaucoma
- Blood clots and bleeding in the eye
- Inflammation inside the eye
- Cataract
Some common side effects that could occur include:
- Red eye (there is usually a bleed on the white part/sub conjunctival space at the point of injection, which clears in a week or two)
- Sore and gritty eye (slight ache and discomfort lasting a day or two)
- ‘Blobs’ or ‘small specks’ in your vision (‘floaters’) might be seen for a few days after the injection. Also, there could be transient flashing lights or swirls of light immediately after the injection.
Systemic risks are also very rare, but stroke and heart attack have been reported. Anti-VEGF may be a potential risk to unborn babies, so you should use birth control before your first injection, during your treatment with anti-VEGF injections.
If you have Severe Pain, Reduced Vision, Increased Floaters, or any other concerns, please call our clinic on (03) 8751 8888 immediately; or the Royal Victorian Eye and Ear Hospital Emergency Department on (03) 9929 8666 out of office hours. The address for The Royal Victorian Eye and Ear Hospital is 32 Gisborne St, East Melbourne VIC 3002.
