Anti-VEGF injections for Wet Macular Degeneration (AMD) and Retinal Vein Occlusions
Anti-VEGF eye injections have transformed the treatment of wet age-related macular degeneration (wet AMD) and retinal vein occlusion (RVO). These treatments can reduce retinal swelling, fluid and bleeding, helping to preserve or improve central vision. At Mr Praveen Kumar’s retinal clinics in Reading and Windsor, treatment is individually tailored using detailed retinal examination, OCT scans, OCT-A scan, FAF scans and the patient’s response to treatment.
What is VEGF?
VEGF stands for vascular endothelial growth factor. It is a naturally occurring protein involved in the growth and function of blood vessels. However, when VEGF levels become abnormally high in the retina, it can encourage the growth of fragile abnormal blood vessels and increase leakage from retinal blood vessels.
In wet AMD, abnormal blood vessels grow beneath or around the macula, the central part of retina. These vessels can leak fluid or blood, causing swelling and damage to the delicate central retina. Without timely treatment, this can result in permanent macular damage and scarring.
In retinal vein occlusion, blockage of a retinal vein can cause retinal congestion, haemorrhage and reduced oxygen supply. This can increase VEGF levels and lead to macular oedema, which can significantly affect vision.
Different Anti-VEGF Agents
Several anti-VEGF medicines are used in modern retinal practice. The choice depends on the retinal condition, previous treatment, OCT findings, response to treatment, treatment duration and individual circumstances.
Ranibizumab
Ranibizumab (Lucentis) is an anti-VEGF antibody fragment designed to bind VEGF-A. It has been widely used for wet AMD and retinal vascular conditions, including macular oedema associated with retinal vein occlusion. Ranibizumab has played an important role in establishing anti-VEGF injections as a standard treatment for retinal disease. Ongavia is the biosimilar version of Ranibizumab and if equally effective.
Bevacizumab
Bevacizumab (Avastin) is a full-length antibody that blocks VEGF-A. Although originally developed for cancer treatment, it has been widely used by retinal specialists as an off-label intravitreal treatment for conditions such as macular oedema associated with retinal vein occlusion and other retinal vascular diseases.Its use requires appropriate specialist judgement, preparation and administration.
Aflibercept 2 mg
Aflibercept 2 mg (Eylea) is a VEGF inhibitor that acts as a soluble “decoy receptor”, binding VEGF-A and placental growth factor. It is an established treatment for wet AMD and retinal vein occlusion and has been extensively studied in retinal disease.
For many patients, aflibercept 2 mg can provide effective control of retinal fluid and help maintain visual outcomes over long-term treatment. Lately Afqlir, biosimilar version of Aflibercept 2mg is used widely
Faricimab
Faricimab (Vabysmo) is a newer type of retinal treatment that targets both VEGF-A and angiopoietin-2 (Ang-2). By targeting these two pathways, faricimab can help reduce vascular leakage and abnormal blood-vessel activity.
Its dosing can be personalised according to the patient's response and disease activity. Manufacturers claim longer duration of action requiring less frequent injection and better effectiveness
Aflibercept 8 mg
Aflibercept 8 mg (Eylea HD) is a higher-dose formulation of aflibercept developed with the aim of providing longer-lasting disease control in appropriate patients. It may allow longer treatment intervals for selected patients while maintaining control of retinal disease. The decision to use a longer-acting treatment depends on the individual eye, OCT findings, previous treatment response and the balance between disease control and treatment burden.
Anti-VEGF Treatment for Wet AMD and RVO
Anti-VEGF treatment has changed the outlook for many patients with wet AMD. Early diagnosis and timely treatment are particularly important because untreated leakage and bleeding can cause irreversible retinal damage.
In retinal vein occlusion, anti-VEGF treatment is commonly used when macular oedema is affecting vision. Treatment is guided by retinal imaging and visual response, with the aim of controlling swelling and protecting useful vision.
Mr.Kumar's approach combines detailed clinical assessment with modern retinal imaging, including OCT, to develop an individualised treatment plan. He uses established and newer anti-VEGF therapies where appropriate and adjusts treatment according to retinal findings, visual function and response.
For patients with wet AMD or retinal vein occlusion, choosing an experienced retinal specialist can be particularly important when treatment needs to be monitored over many months or years.
Mr Kumar provides consultant-led retinal and anti-VEGF care in Reading and Windsor, with treatment decisions focused on protecting vision, controlling disease activity and achieving the safest and most appropriate treatment interval for each patient.
Anti-VEGF Treatment Regimes: Loading, PRN and Treat-and-Extend
Anti-VEGF treatment is not simply a single injection. Most patients require a planned course of treatment, followed by regular monitoring with visual assessment and OCT (Optical Coherence Tomography). The exact treatment schedule depends on the underlying retinal condition, the amount of fluid or swelling, visual response and how the eye responds to previous injections.
Loading Treatment
For many patients with newly diagnosed wet AMD, treatment begins with a loading phase. This usually involves a series of injections given at relatively short intervals, commonly monthly, to gain control of active leakage and retinal fluid. The number and timing of loading injections can vary according to the anti-VEGF medicine used and the individual patient's response.
The aim is to control disease activity early and reduce the risk of further permanent damage to the macula.
PRN Treatment
PRN means pro re nata, or “as required”. With a PRN approach, the patient attends regular monitoring appointments, usually including OCT, and receives an anti-VEGF injection when there is evidence of active disease, such as new or persistent retinal fluid, haemorrhage or deterioration in vision.
PRN treatment can reduce the number of injections for some patients, but it requires reliable and frequent monitoring. If active disease returns between treatments, further injection may be required.
Treat-and-Extend Treatment
Treat-and-extend is widely used in the long-term management of wet AMD and is also used in selected retinal conditions. The patient receives an anti-VEGF injection at each treatment visit, while the interval between injections is gradually adjusted according to the eye's response.
If the retina remains stable and OCT shows good disease control, the interval between injections can be extended. If fluid or other signs of disease activity return, the interval may be shortened.
The advantage of a treat-and-extend approach is that it aims to maintain control of retinal disease while reducing the frequency of hospital or clinic visits where it is safe to do so. It can be particularly useful for patients who require treatment over many years.
Individualised Anti-VEGF Treatment
There is no single treatment schedule or single agent that is right for every patient. Mr Praveen Kumar assesses each eye individually, using clinical examination, visual symptoms and OCT retinal imaging, OCT A scans as well as FAF scans to determine the appropriate treatment interval.
For patients with wet AMD or retinal vein occlusion, the treatment plan may change over time depending on the response to injections. Some patients may achieve longer treatment intervals, while others may require more frequent treatment to maintain control.
The overall aim is to suppress retinal disease activity, preserve useful vision and minimise unnecessary treatment and clinic visits, while recognising that long-term monitoring is an essential part of successful retinal care.