Anti-VEGF treatments are a group of medicines which reduce new blood vessel growth (neovascularization) or swlling (edema). They can be used to treat a number of eye conditions which cause new blood vessel growth or swelling under the macular area of your retina. In 2014, there were over 30 million injections administered  worldwide.

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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.

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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.

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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. We at Vision first take utmost care that you receive injection with comfort.  The following are basic steps for giving an anti-VEGF injection; however, your hospital may have their own procedures:

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• 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. This 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, the eye will be patched for about 1-2 hour and you will be given antibiotic drops to take afterwards.

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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.

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Complications

The risk of complications from the anti-VEFG injections are small, most of these are due to the having an injection into your eye.

These include:

• Endophthalmitis (infection of the eye): This is a serious infection of the eye, the symptoms which are usually quite severe would include a burning sensation, your eye would be very painful and your sight would become blurred and you may become sensitive to light. You eye may also appear red. The risk of getting endophthalmitis from an injection into the eye is about 1 in 1,000, i.e. one person in a thousand who has an injection on average gets an infection. The antibiotics you are given before and after the injection are to prevent this type of infection but some hospitals feel cleaning the eye well at the time of the injection is just as effective.

• Raised eye pressure: The intravitreal injection increases the amount of fluid in your eye and therefore may increase your eye pressure for a short time after the injection. Usually this increase in eye pressure is temporary and doesn't cause any long-term problems.

• Retinal detachment, bleeding and cataract formation: In the trials for anti-VEGF treatments these complications occurred in less than 1 in 100 people treated.

• There is a theoretical slight increase in strokes in people treated with anti-VEGFs; however the actual risk of stroke with anti-VEGF is unknown.

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Outcomes

Anti-VEGF treatment has made a significant impact on the vision and lives of people affected with these conditions. In the case of wet AMD the treatments have stabilised the sight in over 90 per cent of cases and resulted in significant improvement in up to 30-40 per cent of people. For people with macular oedema following retinal vein occlusion, improvement was seen in around 60 per cent of people and for people with diabetic macular oedema improvements were seen in around 30 per cent of people.

Since the use of anti-VEGF treatments for conditions other than wet AMD is fairly new, more evidence should become available about how effective a treatment it is for these conditions.

Although anti-VEGF can mean a lot of treatment and visits to the hospital for you, studies have suggested that it is the best treatment available for these three conditions. You should ask your ophthalmologist what they expect the outcome to be for your particular case, as they will be able to take into account your individual circumstances and eye condition.

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Specific diseases 

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Wet ARMD

Usually you will start your treatment by having three injections once every four weeks; this is known as a loading dose. The ophthalmologist will then use the results of your ongoing tests to decide when you need more injections. Some people may need to have an injection once a month on a regular basis until the bleeding and swelling are brought under control and their sight stabilises. Other people may have months when they don't need any treatment and their injections are more spaced out over the year. Most people who are being treated with anti-VEGF for wet AMD should have a monitoring appointment at their hospital clinic once every month but some anti-VEGF treatments require two-monthly visits rather than monthly visits. Your ophthalmologist can explain the different anti-VEGF drugs available.

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Macular oedema caused by retinal vein occlusion

Again you may start with a loading dose of anti-VEGF treatment of three injections over three months. You ophthalmologist will then determine how well you are responding to the treatment by the results of your tests. They may want to see you fairly regularly at the hospital for the first six months and then perhaps less so for the next 12 months. You must be seen earlier if you notice a change in your vision.

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Diabetic maculopathy

You will usually have a loading dose of three or four injections over a period of 3-4 months. You may then have to visit the hospital at monthly intervals for monitoring and treatment if needed. Your ophthalmologist will use the results of your tests and any changes or improvement in your vision to decide whether you need treatment or not.

Because the treatment with anti-VEGF treatments for macular oedema caused by retinal vein occlusion and diabetes is a fairly new development, the timings and frequencies of your injections and how often hospital visits need to take place isn't fully agreed on as yet. However for anyone having anti-VEGF treatment it is usually necessary to have frequent check-ups at the hospital to ensure that there is no deterioration in vision between treatments.