Treatments for wet age-related macular degeneration
Wet AMD is treated with anti-VEGF injections into the eye. It sounds far worse than it is. Most people find their first one much easier than they expected, and by the third they are largely untroubled by it.
These are the questions that come up in clinic.
What is being injected, and why?
Wet AMD is driven by a protein called VEGF, which makes abnormal blood vessels grow and makes vessels leak. Fluid collects at the macula and central vision blurs and distorts.
Anti-VEGF drugs block that protein. The abnormal vessels shrink, the leaking stops, and the retina dries out.
The drug has to go into the vitreous — the gel filling the back of the eye — because tablets and eye drops cannot reach the retina in any useful concentration. A very small volume, about a fiftieth of a teaspoon, is placed exactly where it is needed.
Which drug will I be given?
Several are in use, and they work in slightly different ways:
- Aflibercept (Eylea) — a fusion protein that acts as a decoy VEGF receptor. Often allows longer intervals between injections.
- Ranibizumab (Lucentis) — an antibody fragment that binds VEGF directly.
- Faricimab (Vabysmo) — blocks VEGF and a second pathway, angiopoietin-2, which can extend the interval further.
- Bevacizumab (Avastin) — a full-length antibody. Effective and considerably cheaper, though its use in the eye is off-label.
- Brolucizumab (Beovu) — a newer option with high VEGF affinity.
The choice depends on your condition, your response, and what is available to you. If one is not controlling the fluid well, switching to another is common and often works.
What else are these injections used for?
The same treatment is used for a range of retinal conditions driven by leaking or abnormal vessels:
- Diabetic macular oedema
- Retinal vein occlusion
- Myopic choroidal neovascularisation, in people with high short-sightedness
- Retinopathy of prematurity, in specialist paediatric units
The principle is the same in each: block VEGF, the abnormal vessels shrink, the leaking stops.
Will it hurt?
Not really, and this is the question everyone asks.
Anaesthetic drops are repeated over several minutes until the eye is thoroughly numb. Most people describe a sensation of pressure rather than pain, lasting a couple of seconds.
The eye is usually gritty and sore for a few hours afterwards as the anaesthetic wears off. That settles.
Will I see the needle coming?
No. The drops blur your vision and you are asked to look away from where the injection is given. Most people see nothing more than a change in the light.
Some people see floaters or a dark shape moving in the vision immediately afterwards. That is the drug itself in the vitreous, and it settles over a day or two.
What happens on the day?
Your vision is checked, then an OCT scan, which shows exactly how much fluid is present. That scan determines both whether you need an injection today and when the next one is due.
Then dilating drops and anaesthetic drops. The eye and lids are cleaned with iodine antiseptic — this is what stings most, and it is also what makes the procedure safe. A small clip holds the lids open so you cannot blink.
The injection itself takes a few seconds.
Aftercare: the first 24 hours
Use lubricating drops liberally. Preservative-free artificial tears every hour or two for the first day make a real difference to the grittiness. This is the single most useful thing you can do, and most people are not told it clearly enough.
Take simple painkillers if you need them.
Wear sunglasses — your pupil is dilated.
Do not rub the eye. This is the most important instruction here. The surface is numb, so you cannot feel damage you might be doing, and rubbing risks introducing infection. If it feels gritty, use a drop, not a knuckle.
Do not drive. Your pupil is dilated and your vision blurred. Arrange a lift — for every injection, not just the first.
Also avoid swimming for a few days, eye make-up for 24 to 48 hours, hot tubs and saunas for a few days, and washing the eye with tap water.
Normal activity, work, walking, bending and light exercise are all fine. There is no need to lie still.
What is normal afterwards?
Grittiness and a foreign-body sensation for a day. Redness — sometimes a bright red patch on the white of the eye where a tiny vessel has bled, which looks alarming and is harmless, and clears over a week or two. Mild blurring. A few new floaters.
All of this should be settling day by day.
What are the warning signs?
Infection inside the eye — endophthalmitis — is rare, of the order of one in a few thousand injections. But it is serious, it moves fast, and it needs treatment within hours.
Contact the clinic urgently, or attend an emergency eye department, if you develop:
- pain that is increasing rather than settling
- vision that is getting worse rather than better
- increasing redness over 24 to 48 hours
- marked light sensitivity
- a sudden increase in floaters, or a shadow across your vision
- any sense that the eye is deteriorating rather than recovering
The distinguishing principle is direction of travel. Grittiness, redness and blurring that are settling day by day are normal. Anything getting worse after the first 24 hours is not, and needs to be seen the same day.
Please do not wait until the next working day to see whether it improves. Nobody will think you overreacted, and the cases that do badly are almost always the ones that waited.
What are the other risks?
Endophthalmitis above is the one that matters most urgently. The others are worth knowing about, and all are uncommon.
A temporary rise in eye pressure immediately after the injection, from the extra volume in the eye. It usually settles within minutes. If you also have glaucoma, tell us — it is worth checking, and it may change how the injection is given.
Inflammation inside the eye (uveitis), causing redness, discomfort and blurring. Treatable, but needs assessing rather than waiting out.
Bleeding into the vitreous, which can cause a sudden increase in floaters or blurring.
Retinal detachment — rare, but it is why a sudden shower of floaters, flashing lights or a shadow coming across your vision needs same-day assessment.
Cataract, which can develop or progress with repeated injections over years. It is treatable with routine cataract surgery when it becomes visually significant.
Set against these: untreated wet AMD causes severe central vision loss in most people. The balance is firmly in favour of treatment.
Why do I need so many?
Because anti-VEGF drugs control the disease rather than cure it. The drug clears from the eye over weeks, and if the underlying process is still active, the leaking returns.
Treatment usually starts with monthly injections to dry the retina out, then the interval is gradually extended — treat and extend — guided by your OCT scan at each visit. Some people stretch to eight, twelve or sixteen weeks. Some need to stay closer together.
This is why the scan matters every time. The interval is not a guess; it is set by what your retina is actually doing.
Can I stop?
Not without discussing it. Stopping while the disease is still active allows the fluid to return, and vision lost that way is often not fully recovered.
If you are finding the burden difficult — and it is a real burden, in time, travel and lifts — please say so. There are longer-acting options and different intervals. That is a far better conversation than quietly stopping.
Next steps
Patients — contact the clinic to arrange an appointment.
GPs and optometrists — refer directly to Limerick or Ennis, including by Healthmail.