If you are diagnosed with wet age-related macular degeneration, diabetic retinopathy, retinal artery or vein occlusion, or any other condition leading to macular edema you will be prescribed intravitreal injections of an anti-VEGF medication. The three most prevalent anti-VEGF medications currently used are Avastin, Lucentis, and Eylea.
Avastin is a medication that is used to reduce swelling and abnormal blood vessel growth. It was originally developed for the treatment of colon cancer but has gained worldwide acceptance for the successful treatment of several eye conditions. The company that developed this medication has never applied to Health Canada or the FDA to seek approval for intraocular use. It remains approved only for cancer treatment, and therefore its use in the treatment of eye conditions is considered “off label”.
In contrast, Lucentis and Eylea were developed for intraocular use, and are approved by both the FDA and Health Canada for the treatment of some eye conditions. Lucentis and Avastin are very similar on a molecular level. In fact, Lucentis is just the active fragment of the larger Avastin molecule, and therefore they work very similarly. All three of these medications are used frequently by retinal specialists, and your retinal specialist will help determine which medication is right for your eye. Eylea is a VEGF trap, which is a different type of molecule than Avastin and Lucentis.
Avastin, Lucentis and Eylea work by reducing swelling and also inhibiting abnormal blood vessel growth. They have truly been a major advance in the treatment of retinal conditions, and one of the most exciting innovations in modern medicine in the last decade. Prior to these medications, the treatment options for many retinal problems were very limited and ineffective. Lucentis and Avastin injections have saved the vision of countless patients world-wide who would otherwise have almost certainly been blinded without treatment. While the treatment may sound scary, you can rest assured that the injections are almost always safe and painless.
Typically, injections are started on a monthly basis for the first few months of treatment. After the first three injections, the need for ongoing treatment is re-evaluated. Most patients do require ongoing injections even after the first few months, but often no longer need the medication on such a frequent basis. Dr. Mitchell or Dr. Adatia will tailor your treatment to your eye’s specific needs, ensuring you receive only as much medication as is necessary to maintain your vision.
After injections, the following post injection instructions are very important:
- Keep your eye clean and avoid dusty, dirty or windy environments for 48 hours
- Do not get any water in your eye for at least 48 hours, including while in the shower. Do not swim or use a hot tub for at least 48 hours.
- Do not rub your eye. If the eye feels irritated use a fresh bottle of artificial tears to lubricate and soothe the eye. These are provided to you at the time of the injection. Do not use old, previously opened bottles of tears as their sterility cannot be guaranteed.
- Avoid travel outside of Canada for at least 4 days after an injection. In the extremely rare event that a complication develops, it is important that you have prompt access to medical care. If you take medication eye drops in the injected eye you may restart them the day after the injection.
- It is normal following an injection to experience some aching or irritation in the eye. Most of this irritation is actually due to the drops used to sterilize and numb the eye for the procedure, and should subside within 12 to 24 hours. If the pain persists for longer than this you should contact our office. It is also common to notice some bleeding and redness on the white part of the eye after an injection. This is harmless to the eye but can take 7-10 days to resolve, during which time the eye should be painless.
- It is extremely rare to develop an infection inside the eye, also known as endophthalmitis, after an injection. However, it is very important to identify this complication as soon as possible if it develops. Typically, symptoms include worsening pain (past the initial 12-24 hours), progressive reduced vision, worsening light sensitivity, and worsening redness or discharge from the eye. Please contact our office immediately at 403-258-1773 or seek medical care if any of these symptoms develop.
Finally, several studies have investigated injections in the eye and shown them to be safe for your general health. Nonetheless, because these medications influence blood vessels there is a theoretical risk of stroke, heart attack, blood clots in the legs or lungs, or gastrointestinal side effects. If symptoms develop that suggest any of these conditions, please seek immediate care at your nearest emergency department.