Anti-growth factor injections for wet macular degeneration

Written by: Mr Vaughan Tanner
Published:
Edited by: Karolyn Judge

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.

 

Close up of a specialist holding an injector treatment

 

 

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.

 

 

Mr Vaughan Tanner provides vastly-experienced and expert guidance. If you are looking for anti-growth factor injections or age-related macular degeneration advice, please visit his Top Doctors profile here for more information.

By Mr Vaughan Tanner
Ophthalmology

Mr Vaughan Tanner has over 20 years experience as a senior consultant ophthalmic surgeon to The Royal Berkshire Hospital, Reading and King Edward VII Hospital, Windsor. During that time, he led the Berkshire-wide vitreo-retinal surgical service, established a sub-specialist age-related macular degeneration service, provided a micro-incision cataract service and headed a general ophthalmic team providing care for acute and routine eye conditions. He now focuses on providing a private practice, centre of excellence for both cataract and retinal surgery. His subspecialist interests and recent advances include the introduction of sub-2mm micro-incision cataract extraction with multifocal and toric lens implants designed to significantly reduce spectacle dependence following cataract surgery.
 
He has also developed sutureless small incision vitrectomy techniques for the repair of retinal detachment, epiretinal membrane, macular hole and other vitreoretinal diseases. Mr Tanner’s extensive surgical experience includes the performance or supervision of over 15,000 major intraocular cataract and retinal procedures.

Mr Tanner has led the introduction of many new retinal treatments including Faricimab, Lucentis, Eylea anti-growth factor, intravitreal injections and Ozurdex steroid implants. These innovations have significantly improved vision for many patients suffering from age-related macular degeneration, diabetic retinopathy, retinal vein occlusion and other retinal problems.

In the private sector, he has developed a comprehensive service aiming to provide the highest level of personal care using the latest surgical techniques available. His main practice covers Berkshire, Oxfordshire, Surrey, Buckinghamshire, Hampshire and London with many national and international referrals. Private consultations and treatments are available at the following The Princess Margaret Hospital, Windsor, Dunedin Hospital, Reading and Circle Hospital, Reading.

His undergraduate study was at St George’s Hospital Medical School, London where he was awarded Medical Research Council funding in addition to his medical degree. His completion of higher surgical training at the Oxford Eye Hospital led to the award of the Fellowship of the Royal College of Ophthalmologists. He then completed three years of advanced, sub-specialist fellowships at both Moorfields Eye Hospital, London and St Thomas’ Hospital, London. During this period he gained expertise in the surgical and medical management of all retinal disorders including macular surgery. He has co-authored “Diseases of the Ocular Fundus” which was awarded first prize as “Best Authored Post Graduate Textbook” by the Royal Society of Medicine and the Royal Society of Authors. He has previously hosted both the Southern and National Annual Meetings of the British and Eire Association of Vitreo-Retinal Surgeons. He is an invited scientific reviewer for the British Journal of Ophthalmology.

Furthermore, Mr Tanner was a consultant clinical supervisor for The Oxford Deanery School of Ophthalmology responsible for post-graduate training and also led a fellowship training programme in advanced vitreo-retinal surgical techniques for surgeons becoming consultants in this sub-specialty. He has previously been appointed both lead clinician and clinical governance lead for the ophthalmology department, Royal Berkshire Hospital and has been awarded three NHS clinical excellence awards. He is currently appointed ophthalmology lead for the Medical Advisory Committee at Princess Margaret Hospital, Windsor.

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