What is the purpose of the injectable medications
for wet AMD?
Chorodial neovascularization (abnormal blood
vessels) can cause severe visual loss by growing
underneath the center of the macula, bleeding and
causing a scar. The goal of injectable medications
is to stop and leakage of CNV. This can stabilize
vision in almost all patients and can improve vision
in many patients.
How is the medication injected into the eye?
In most cases, the injection is done in the doctor's
office. The eye is made numb with anesthetic
medications. Then the eye is sterilized with a
disinfectant solution. The eyelids are held open and
the injection is made through the white portion of
the eye using a fine needle.
What restrictions are there after the injections?
Many patients may have some mild irritation the day
of the injection. This typically is gone by the
following day. You should be able to perform most
routine activities after the medication is injected
into the eye. Report severe pain or vision loss
What is the difference between Macugen, Lucentis,
All threee of these drugs inhibit the growth factor
VEGF(vascular endothelial growth factor). Macugen
and Lucentis have been approved by the FDA for use
inside the eye after large, well-conducted research
studies proved their effectivness. Macugen blocks
one form of VEGF while Lucentis inhibits all forms
of VEGF. Lucentis appears to be superior in its
ability to stabilize and improve vision.
Avastin is a drug designed to be injected into the
vein of patients with colon cancer. It also blocks
all forms of VEGF and has been used for injection
inside the eye in patients with wet AMD. While this
is not an FDA approved use of the drug, there is
evidence that it can reduce blood vessel growth and
retinal swelling in people with wet AMD. Unlike
Macugen and Lucentis, there is no large research
study that proves this without a doubt. Such a study
is underway. Your doctor will discuss the pros and
cons of these drug injection therapies and help you
decide which is best for you.
The cost of these drugs has drawn a great deal of
discussion. Lucentis is a very expensive drug;
whereas, Avastin is inexpensive. For this reason,
Avastin is the anti-VEGF drug used most commonly in
the rest of the world outside the United States.
Studies comparing Lucentis and Avastin will detemine
whether Avastin works as well as Lucentis.
What should I expect after the medication injection
into the eye?
A numbing medication is very effective in preventing
pain. In most cases, the injection causes only
slight discomfort. Immediately after the injection,
the eye can feel irritatied for a few hours to a
day. The eye is usually red and this redness can
last for a week or two. The vision may be blurrier
for the first two days after the injection. Severe
vision loss or pain should be reported to you doctor
immediately as this may be a sign of a problem such
as inflammation or infection.
How many injections will I need?
Research has shown that repeat injections every four
to six weeks may be needed for up to two years. Less
frequent injections may work for some patients. Your
doctor may perform tests, like fluorescein
angiography and OCT, during your treatment to
determine if fewer injections are possible. Studies
are being performed to see if the number of
injections can be decreased by combining the
anti-VEGF drugs with other treatments, like PDT.
Will I get my vision back after the drug is
The main goal of therapy is to prevent further
vision loss. Up to a third of patients have
improvement in their vision after medication
injection therapy. There is no way of knowing who
will have improvement with treatment, but the sooner
you receive the injectable medications, the better.
Do the injected drugs permanently destroy the
CNV(abnormal blood vessels)?
NO. The drugs work to impair the growth of the CNV
by temporarily blocking the growth factor that
causes CNV. The efect of the injectable medication
is only temporary and multiple injections will
likely be necessary.
How safe are these injections?
About one to two in every 1000 injections will cause
a problem. The most common problem is inflammation
that can cause eye pain and vision loss. Sometimes
the inflammation is due to an infection that can
cause blindness if left untreated. Another rare side
effect of these injections is stroke. Stroke, which
can cause problems like weakness in a part of the
body or difficulty speaking, may occur more
frequently in patients receiving an injection.
Further research is being conducted on stroke risk.
Your doctor will discuss with you the relative risks
and benefits of the injectable medications.
If I don't regain my vivsion, how will I get along?
Macular Degeneration usually causes loss of central
vision only and the peripheral vision remains.
People with severe macular degeneration may be
unable to read small print or drive but can usually
care for themselves. Your doctor may ask you to see
a low vision specailist who can prescribe special
magnifiers and other devices that can allow you to
see slightly better.
Is Macular degeneration a genetic disease? What
should my children do?
There has been research to indicate that macular
degeneration is due to genetic changes in many
people with the disease. Genetic testing is not
widely available and is not routinely done. Children
over the age of 50 of people with macular
degeneration should have their eyes examined by an
eye doctor to determine if they would benefit from
What can I do to make sure the CNV(abnormal blood
vessels) doesn't grow in the other eye?
In people with CNV in one eye, there is a risk that
it will develop in the other eye. The only proven
way to decrease the risk of CNV is using the
antioxidant vitamin and minerals proven beneficial
by the Age-Related Eye Disease Study. Smoking
increases your risk for vision loss with macular
degeneration, and you should do your best to stop
smoking. There are special vitamin formulations for
smokers. discuss with your doctor what you should be
taking. If you have CNV in one eye, it is important
to carefully monitor your vision in the other eye
and report any changes to your eye doctor
immediately. early treatment can prevent severe
Are laser and PDT safe?
In the majority of cases, no complications occur
but, as with all surgery, there are some risks.
There is a remote chance that the laser beam might
not be aimed properly and the healthy retinal tissue
might be destroyed. Also, laser and PDT may cause
bleeding or an unusually large scar. fortunately,
these comlications are rare.
Because of the intense brightness of the laser beam
used for both PDT and laser treatment, there is a
light-dazzle or "flashbulb" effect. The eye may taek
a few hours to recover from this glare. If you have
had your eye anesthetized and are wearing a patch,
you probably will not notice this light-dazzle or
Will the CNV(abnormal blood vessels) be permanently
destroyed by laser or PDT?
In many cases, the growth of CNV(anbormal blood
vessels) is stopped after treatment with laser, or
with multiple treatments with PDT. However, it is
quite possible for additional abnormal blood vessels
to grow at some time after treatment. If CNV grows
after laser or PDT, your doctor will discuss with
you the possibility of other treatments, including
the intravitreal injection of anti-VEGF drugs.
How many laser treatmaents will I need?
Generally, only one laser treatment is necessary.
But additional CNV(abnormal blood vessels) does
occur in about half of those who have had laser
surgery and for some of them additional laser
treatment may be possible. For PDT, often three of
four treatments are necessary for the first year.
Can anything help if central vision is lost in each
Anyone who has lost detail vision in both eyes may
be referred to a low vision specialist who will
teach those techniques that use the remaining vision
to its fullest. Low vision specialists can fit
magnifying lenses for close-up vision and telescopic
lenses for seeing at a distance. There are other
visual and mechanical devices suach as filters,
increased lighting and special reading aids that can
help with the goal of living life to the fullest
even with reduced vision. Low vision counselors have
information about books on tape, radio programs that
read the news and support groups that meet to help
people cope with the problems of central vision
Are there any medicines or dietary supplements
helpful for macular degeneration?
Specific vitamins and minerals have been shown to
reduce the risk of vison loss in some patients with
AMD. Studies are being conducted to see if other
nutritional supplements may be helpful in delaying
the progression of AMD. Ask your doctor if you
should supplement your diet with vitamins and
Is it normal to have trouble adjusting quickly
between bright sunlight
and dim light or shadow?
Many elderly people, and especially those with
have difficulty adjusting quickly from bright light
to dim light or
shadow. It might be difficult driving in bright
sunlight and then
seeing when driving into a dark tunnel. Some may
find it difficult to
read the menu in a dark restaurant when they have
just come in from
bright daylight. This problem may be helped by using
over regular glasses. These clip-on sunglasses can
be slipped off
easily when going from light to dark and can then be
slipped back on
again when going from dark to light. Bright light
for reading is often very helpful. Many people with
drusen, or other forms of macular degeneration,
experience difficulty driving at night and, in such
cases, may find it best to avoid driving at night.
If I have dry AMD, do I have to worry about getting
People with dry AMD may also develop abnormal blood
vessels(CNV) under the retina. This is why your
doctor may recommend using vitamins and will
instruct you to report changes in your vision
Does combining the treatments, for example, PDT and
a drug injection, improve my chances of keeping
Research is being done to see if, by combining
treatments, a patient may improve his or her chances
of keeping vison. These studies may show us if there
are ways to decrease the number of injectable
medications needed to preserve, or improve visions
beyond what can be achieved with the injectable
medications alone, there may be the benefit of
needing fewer injections to ahcieve the same goal.