How many injections will I get for macular degeneration?

One of the most common questions we get asked by patients receiving injections for exudative (wet) macular degeneration is how many injections that they will have to receive.  Understandably, most patients are anxious to decrease or even stop their injections all together.  The answer, however, is variable depending on the patient.

Exudative macular degeneration is a chronic disease where the blood vessels in the choroid (the back of the eye) grow through a barrier called Bruch's membrane and bleed.  This bleeding leads to fluid in the macula which is what leads to decreased vision.  Chronic fluid and blood can lead to scarring and eventually markedly decreased central vision. The primary driving force between these blood vessels is a protein called vascular endothelial growth factor (VEGF).  The medications that we currently use to treat macular degeneration-  including Avastin, Lucentis, and Eylea-block this protein (anti-VEGF medications).

When the anti-VEGF medications are injected into the eye they only have an effect for about 28 days. After the medications wear off, the VEGF proteins made in the eye rise again and cause the vessels to leak or grow.  That is why the medications have to be injected at regular intervals.  I often compare this to having to take your blood pressure medication every day to keep your pressure under control.  The medications aren't a cure, but a treatment.

In the initial trials for anti-VEGF medications, the injections were continued every 28 days for 2 years regardless of the patient's vision or amount of fluid in the retina.  The results were excellent- stabilization of vision in most patients and increased vision in many patients.  In the years since the initial trials, a few different approaches have been tried to decrease the number of injections including treating only as needed when fluid returns, and a treatment called treat and extend where we gradually increase the time between injections. One medication, Eylea, is often used very 8 weeks after a 3 to 6 month initiation with monthly injections with good success.

One recent trial, HORIZON, examined the use of as needed injections and revealed that patients lost some vision that they had initially gained when only receiving the injections as needed (when fluid returned in the macula) instead of on a strict schedule.  So, many retina physicians concluded that either monthly treatments or a slow treat and extend regimen is more beneficial to the patient.  And, we know that if we stop the injections all together, the blood often returns and leads to severe central vision loss.

As cumbersome as monthly injections seem to you as a patient, it is important to realize the benefit you are likely receiving from your injections.  The anti-VEGF medications have revolutionized the treatment of this blinding disease and have given hope to many patients who did not have a good visual prognosis in the past.

Researchers are working to develop longer acting medications and other methods that could help avoid these monthly or ever other month injections, so some day in the future you may be able to decrease your visits to the retina physician for macular degeneration treatment.

Each patient is different and is evaluated by his or her physician to determine the best course of treatment.

This blog is for informational purposes only and is not intended to be medical advice.  Please consult your physician for any medical advice.

Central Retinal Vein Occlusion Treatment

On 9/24/12, the FDA approved Eylea for treatment of central retinal vein occlusion (CRVO). What does this mean for you?

One of the most common causes for decreased vision after a CRVO is macular edema, or swelling of the center part of the retina.  Before Anti-VEGF therapy, the options for treatment were limited to steroid injections as laser did not prove to be effetive in the CVOS trial.  While steroids do have some benefit, the results were often disappointing.

Avastin (bevacizumab) injections were originally used to treat exudative macular degeneration.  Successful use of Avastin for macular edema in patients with a CRVO led to the increasing use of this therapy.  A Genentech sponsored a trial, CRUISE, demonstrated that patients receiving Lucentis (ranibizumab) gained 12.7 letters at month 6 compared to a 0.8 letter gain in sham injections. 

Eylea (aflibercept), an Anti-VEGF trap medication was approved for the treatment of macular degeneration in 2011.  A recent trial sponsored by Regeneron, COPERNICUS, compared the use of Eylea to sham injections.  Patients receiving Eylea gained17.3 letters compared to a 4 letter loss in the sham injections.

The treatment options are expanding and patients with a CRVO have more choices than ever for vision restorative therapy.

NC Retina offers Eylea at all five of our locations.

This is not intended to be medical advice.  Please seek an eye care professional for diagnosis or treatment.


Please visit us at www.ncretina.com