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Intravitreal Anti Vascular Endothelial Growth Factor (VEGF) therapy

Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 years of age. There are two types of macular degeneration: dry and wet. In the “wet” form of AMD, abnormal blood vessels grow in the back of the eye. Sometimes these vessels leak blood or fluid that causes blurred or distorted vision. Without treatment, vision loss may be quick and severe.

  • There are other eye conditions that cause loss of vision due to abnormal growth of blood vessels in the back of the eye. These can occur even in young patients, and include, but are not limited to, conditions such as high myopia (nearsightedness), histoplasmosis, angioid streaks, and eye injury. Sometimes there is no known reason for the abnormal blood vessels. Without treatment, vision loss may be quick and severe.
  • Refractory macular edema, or swelling around the macula, is edema that affects vision but does not respond adequately to the usual treatment methods. It can occur with conditions such as central retinal vein occlusion and diabetic retinopathy. Without effective treatment, vision loss could progress and become permanent.

Types of Anti VEGF agents


Lucentis (ranibizumab) is a humanized anti-VEGF antibody fragment that inhibits VEGF activity by competitively binding with VEGF. The Food and Drug Administration (FDA) has approved Lucentis treatment for wet macular degeneration patients.

  • About 95% patients with wet macular degeneration maintain their baseline vision after 12 months of treatment with Lucentis. The vision loss, if any, is less than 15 letters of visual acuity. This level of vision loss is considered to be not clinically significant. This is an important treatment effect because to date all other available treatment options at best delay the inevitable vision loss but do not prevent ongoing vision loss. The results from Lucentis clinical trials support its use to prevent further vision loss from wet macular degeneration.
  • About one-third patients gain vision after 12 months of treatment with Lucentis. This vision gain is clinically significant - defined as gaining more than 15 letters of visual acuity. This is perhaps the most significant reason for initiating Lucentis treatment in wet macular degeneration. The vision gain after Lucentis treatment enables the patients to doing things like reading again, however not everyone will get such a positive outcome. There is no other macular degeneration treatment that has been shown to improve vision in the settings of a FDA controlled clinical trial.
  • Long term data is not available to fully assess the effects of Lucentis.

Eylea is a type of anti-VEGF drug known as a fusion protein and is directly injected into the eye to treat wet AMD. Eylea targets VEGF, as well as another protein called Placental Growth Factor (PlGF), which has also been found in excess amounts in the retina of people with wet AMD. After an initial 3 monthly injections, further injections of Eylea every other month show comparable effectiveness with monthly injections of Lucentis. Clinical trials of about 2,400 people with wet AMD compared monthly injections of Lucentis with injections of Eylea given monthly for three months, and then given every other month. After one year of treatment, bimonthly Eylea was shown to improve or maintain vision in AMD patients at a level comparable to monthly Lucentis. The safety of both drugs was also comparable. Overall, patients who were given Eylea needed fewer injections to achieve the same effectiveness as monthly injections of Lucentis.


Avastin TMwas not initially developed to treat eye conditions. Based upon the results of clinical trials that demonstrated its safety and effectiveness, Avastin TM was approved by the Food and Drug Administration (FDA) for the treatment of metastatic colorectal cancer. As a condition of approval, the manufacturer produced a “label” explaining the indications, risks, and benefits. Ophthalmologists are using Avastin TM “off-label” to treat AMD and similar conditions since research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions. Some patients treated with Avastin TMhad less fluid and more normal-appearing maculas, and their vision improved. Avastin TM is also used, therefore, to treat macular edema, or swelling of the macula.


Possible complications and side effects of the procedure and administration of Anti VEGF therapyinclude but are not limited to retinal detachment, cataract formation (clouding of the lens of the eye), glaucoma (increased pressure in the eye), hypotony (reduced pressure in the eye), damage to the retina or cornea (structures of the eye), and bleeding. There is also the possibility of an eye infection (endophthalmitis). Any of these rare complications may lead to severe, permanent loss of vision.