The blurred vision or blind spots caused by wet macular degeneration are disorientating symptoms of a condition that is thankfully treatable, especially if it is detected early. Furthermore, past treatment has been improved recently in the form of new anti-growth antibodies.
Senior consultant ophthalmic surgeon Mr Vaughan Tanner details a new technique using these antibodies, which has considerably improved vision in many patients, as well as the risk involved in the injections required.
Significant advances in the management of wet age-related macular degeneration over the last few years have meant the introduction of intravitreal vascular endothelial growth factor antibodies (anti VEGF). This revolutionary treatment, which is commonly administered using drugs called either Eylea (Aflibercept) or Lucentis (Ranibizumab), has resulted in a significantly lower rate of visual loss compared to previous treatments.
It has been found that after anti VEGF treatment, which is done via a series of injections into the eye, a significant increase in vision has shown in up to 40 per cent of people with any form of wet age-related macular degeneration. The rest of those people studied benefitted from a stabilisation of vision and better visual outcomes than if left untreated.
Lucentis and Eylea (anti VEGF antibody fragments that bind VEGF isomers) are fully licensed in the UK and have become the standard treatment for wet age-related macular degeneration as well as other retinal conditions like vein occlusion and diabetes.
Both Lucentis and Eylea have been shown to provide significantly better visual improvement than older laser techniques in numerous clinical studies.
How is treatment for wet age-related macular degeneration administered?
A series of three-monthly injections of Lucentis is given followed by a review of the retina with optical coherence tomography scanning. Subsequent treatment spacing is then individualised, based on each patient’s response. This ‘treat and extend’ regime is designed to try and control the leak of fluid and blood into the macular with the minimum number of injections possible. Most patients will need treatment for two years, and a few significantly longer.
Anti VEGF therapy is fully recognised by private healthcare companies as a recommended treatment for wet age-related macular degeneration, diabetic macular oedema, retinal vein occlusion and other conditions affecting the retina where there is macular swelling.
What happens in the procedure?
Each intravitreal injection is administered in the sterile conditions of an operating theatre environment in order to minimise the chance of any infection. The injection, which isn’t painful, takes a few minutes and will be given following the application of anaesthetic drops. The volume of drug injected is tiny, usually 0.05 ml, and is via a very small needle.
The quick out-patient procedure allows patients to leave the clinic almost immediately after their injection.
After the injection, you may notice some irritation and redness of the eye over the next few days. Additionally, there may be eye floaters in the vision. However, irritation should be mild and other side effects will resolve fairly quickly.
What are the risks involved in the process?
There is approximately a 0.1 per cent risk (one in a thousand) of developing serious infection in the eye (endophthalmitis) following an injection of any kind. Avoidance of any infective risk is taken seriously and every precaution is made. This involves:
- Application of iodine drops to the surface of the eye before and after the procedure
- Scrupulous attention to sterile technique
Further risks include:
- High pressure in the eye
If high pressure occurs, this usually passes and is related to a short-term build-up of fluid due to the injection.
- Bleeding and retinal detachment
These are complications that, while extremely rare, have been reported
- Thromboembolic events such as a stroke
There is a theoretical systemic risk from anti VEGF agents, that they may increase the possibility of having a stroke. However, studies and trials results have brought about conflicting results. The age group of patients is generally older and needs to be taken into consideration with a frequent, high incidence of other medical problems.