Anti-VEGF treatments are a group of medicines which reduce new blood vessel growth or oedema (swelling). They can be used to treat a number of eye conditions which cause new blood vessel growth or swelling under the macula area of your retina.
Uses of Anti-VEGF treatments
Currently anti-VEGF treatment is used for:
- 'wet' Age-related macular degeneration (AMD)
- Diabetic maculopathy
- Macular oedema caused by retinal vein occlusion.
New blood vessel growth and macular oedema can also occur in other retinal conditions, so in the future anti-VEGF medications may be used in a wider range of situations.
Anti-VEGF treatments are given by an injection into the eye and work by reducing the growth of new blood vessels and the oedema (swelling) they may cause. Doing this can reduce the risk of scarring and damage to the retina caused by these new vessels, which in turn can help to avoid further sight loss and for some people cause an improvement in vision.
The term "anti" means against and "vascular" refers to blood vessels. Anti-VEGF stands for 'anti vascular endothelial growth factor'. These drugs work by stopping a protein called vascular endothelial growth factor (VEGF) produced by cells in the retina from working.
New blood vessel growth is a major problem which occurs in a number of eye conditions. VEGF promotes blood vessel growth in the body. Anti-VEGF drugs can interfere with this process, reducing new blood vessel growth and slowing down any leakage or swelling these new blood vessels may cause. This in turn can help to slow down or hold back any loss sight you may experience.
Depending on the condition you have your ophthalmologist will perform tests to decide whether or not treatment with anti-VEGF medication is right for you and your condition.
After examining your eye, the consultant may undertake further tests to give them a clearer picture or your eye and your symptoms. The common tests used to assess the state of your retina are:
- Slit lamp examination
- Fluorescein angiography
- Optical coherence tomography (OCT).
Slit lamp examination
For this examination the ophthalmologist uses a microscope so that they can see the surface of your retina by looking through your pupil. Usually you will have your pupils dilated for this test. The ophthalmologist will use the microscope to view your retina and is able to see any changes your condition has caused.
A fluorescein angiogram test provides a picture of the layer of blood vessels underneath your retina. Your ophthalmologist is then able to tell how your condition is affecting this layer of blood vessels. This test uses a dye injected into your arm which travels to the blood vessels in your retina. While the dye is travelling through the blood vessels under your retina a series of photographs are taken with special equipment. These photographs will show your ophthalmologist where the areas of leaking blood vessels are located. Your skin and urine may look orange for a few hours after having this test. Rarely some people can have an allergic reaction to the dye being used but your doctors should have the equipment in place to treat this if this occurs.
Ocular Coherence Tomography (OCT)
This non-invasive test is able to produce an image which shows the layers of your retina around the macula area. This test can be very useful at showing swelling in your macula. It can also be used to compare your macula before and after treatment to make sure that the treatment has been effective in reducing the amount of swelling.
These tests may change or extra tests may be performed depending on the condition you have. Your ophthalmologist will be able to tell you which tests you need so they can manage your care.
Anti VEGF treatment
Anti-VEGF drugs are given as an injection into the vitreous (the jelly-like substance inside your eye). The injection is given through the white of your eye (the sclera). The injection needs to be given in a sterile way and you may have the treatment in an operating theatre, though more commonly it may be given in a room which has been designed for this type of treatment (sometimes called a clean treatment room).
The needle used for the injection is small and short and the injection itself only takes a few seconds. As you will have had an anaesthetic drop in your eye the injection feels like a small point of pressure on your eye rather than a scratch. The following are basic steps for giving an anti VEGF injection; however, your hospital may have their own procedures;
- You will be given eye drops which dilate your pupil. This allows your ophthalmologist to see the back of your eye more easily.
- You will also be given local anaesthetic eye drops or a local anaesthetic injection. These will help to make the injection as pain free as possible.
- The eye and skin around your eye will be cleaned to prevent infection.
- Your face and the area around your eye may be covered by a drape to keep the area sterile.
- A small device called a speculum will be used to keep your eye open and prevent you blinking.
- You may have more anaesthetic drops put into your eye to numb it and prevent you feeling pain.
- Once your eye is numb the injection will be given.
- Following the injection, you may be given antibiotic drops to take afterwards.
After your injection your vision may be blurry for several hours because of the dilating eye drops; this should improve by the next day or the day after. The white of your eye may be red where the injection was given but that should disappear in a few days. You may notice black swirls in your vision for a few weeks (this is the drug floating which you can notice in your vitreous gel). Your eye should feel comfortable by the next day. You may be given some eye drops to take for a few days after the injection to prevent you developing an infection.