What to Expect From Eye Injections for AMD

Receiving eye injections for age-related macular degeneration (AMD) can be a real sight-saver for those with this condition. These intravitreal (in-the-eye) injections allow an ophthalmologist to place the medication directly into the vitreous cavity at the back of the eye, where it is needed.

Besides AMD, injections can treat other conditions affecting the light-sensitive retina, such as diabetic retinopathy and retinal vein occlusions (blockages).

These injections deliver medication such as the new geographic atrophy drug Syfovre (pegcetacoplan), powerful anti-VEGFs (vascular endothelial growth factor) to keep abnormal blood vessels from growing, and steroids to tamp down inflammation, as well as antibiotics, antifungal drugs, and antiviral drugs to fight infection.

This article will highlight the various kinds of eye injections for AMD, how injections compare to eye drops, how to prepare for the injections, how to minimize injection-related anxiety, and more.

How Different Types of Eye Injections for AMD Work

Syfovre, anti-VEGF agents, steroids, and medications to keep infections in check are all among the types of intravitreal injections your ophthalmologist may prescribe. For years, anti-VEGF injections have helped to preserve sight in people with wet AMD by controlling the growth of leaky abnormal blood vessels that could otherwise damage the retina in this form of AMD.

Beyond wet AMD, eye injections help treat:

• Geographic atrophy: In this late-stage AMD condition, the macula (responsible for fine vision at the retina's center) thins, and protein deposits build up in the area. This eventually destroys the tissue. The newly approved drug Syfovre works to keep geographic atrophy from progressing by inhibiting a protein in the complement system called C3. Without it, the immune system can overreact and cause retinal cells to die. Geographic atrophy is the second leading cause of vision loss in people over 55 in developed countries, just behind wet AMD.
• Diabetic retinopathy: This condition is a diabetes complication that can cause fluid leakage from abnormal new blood vessels in the retina. To prevent this, ophthalmologists may prescribe injections of anti-VEGF and a steroid medication.
• A retinal vein occlusion: With this condition, a vein carrying blood away from the retina can get blocked. Pressure can build up in the circulation, and there can be leakage of fluid onto the retina. Anti-VEGF agents are commonly prescribed here.
• Uveitis: In these cases, the tissue within the eye becomes inflamed and swells and may leak onto the retina, which anti-VEGF can help to prevent.
• Endophthalmitis: This is an infection inside the eye. For severe infections inside the eye, ophthalmologists may prescribe intravitreal injections of antibiotic, antiviral, and antifungal medication.
• Retinal detachment: If the retina pulls away from the back of the eye, a tiny gas bubble can be injected into the eye to push this back in place and repair the damage.
• Diabetic macular edema: With this condition, fluid collects in the retina. To prevent vision loss, an ophthalmologist can inject an anti-VEGF agent into the retina, where it can reduce swelling.

Are Eye Injections Painful?

While the idea of an eye injection may be alarming, it usually is not painful. In some cases, you may feel nothing, while in others, you may briefly feel some moderate discomfort.

As part of the process (in most cases), the ophthalmologist will put numbing eye drops in your eye so that you will likely only feel some pressure during the injection.

Cost of Eye Injections

Eye injections typically come with a significant price tag, although not always. The anti-VEGF agent Eylea (aflibercept) costs around $1,850 per dose. For treating wet AMD, a 0.5 milligram (mg) dose of Lucentis (ranibizumab) costs between $1,950 and $2,023, and a less concentrated 0.3 mg dose for treating diabetic macular edema goes for around $1,170 per dose.

Meanwhile, Avastin (bevacizumab), which was initially approved by the Food and Drug Administration (FDA) for treating colon cancer, must be used off-label for AMD or diabetic macular edema since it is not FDA approved for these conditions. Still, it is much less expensive at just $50 or $60 a dose.

The new geographic atrophy agent, Syfovre, is priced at $2,190.

Eye Injections vs. Eye Drops

Although the idea of an eye injection may not be as appealing as simply putting in eye drops, there are advantages and disadvantages to both. Here's what to consider.

Pros

Intravitreal injections can be sight-saving. Study results show that over 90% of people receiving anti-VEGF injections maintained their vision. While real-world statistics put this more in line with about 50%, those who keep up with their injections as directed by their provider can likely expect results more in line with the research. 

However, while this treatment can keep abnormal new blood vessels from forming, once the retina is damaged, it currently cannot be reversed.

In studies, Syfovre, which received FDA approval in February 2023, showed as much as a 36% reduction in geographic atrophy lesion growth between the 18- to 24-month marks. Syfovre is the only treatment currently for geographic atrophy. Receiving Syfovre can slow the progression of geographic atrophy but does not reverse it.

Meanwhile, for drops, the big advantage is patient appeal. Research shows that people strongly prefer drops, with around 76% claiming they would prefer this to intravitreal injections. The thinking is this could translate into increased compliance with treatment.

Cons

While eye injections are usually considered safe, there can be complications. Some potential complications to watch for include:

• The threat of endophthalmitis infection in the eye
• A case of pseudo endophthalmitis (inflammation inside the eye without infection) from a reaction to a medication
• Bleeding in the eye from a vitreous hemorrhage
• Retinal detachment

Meanwhile, no drops have yet been shown to be effective in humans for treating AMD.

How to Prepare for Eye Injections

It's natural to be wary of an eye injection at first. The best way to prepare is to understand the process clearly.

Before the injection, the ophthalmologist will numb your eye and use a device to keep you from blinking during the injection. They will also clean the eye surface with an iodine solution.

After numbing the eye, the ophthalmologist will determine where the injection should go. Usually, this will be on the lower part of your eye near your ear. They will likely ask you to look up so they can inject the medication here using a tiny needle.

During the injection, you may see the medication combining with fluid in the eye in the form of a web of lines. That's completely normal.

After completing the injection, the ophthalmologist will examine and clean the eye. Don't be surprised if your eye is sore and your vision is somewhat cloudy for the first few days.

If needed, you can take an over-the-counter pain reliever and use a cool cloth for comfort. You may also need to use antibiotic drops for a few days to prevent infection.

Make sure you have someone available to drive you home immediately after the procedure.

Stay Calm During the Eye Injection

If you're still worried that you may be a little rattled, here are some measures to take that may help you remain calm:

• Ask for music to be played during the procedure.
• Have support in the room, such as a family member, friend, or even another staff member.
• Ask to have a pillow placed under your neck for support.
• Squeeze a stress ball to ease tension.
• If you're undergoing treatment in both eyes, ask that both procedures be done on the same day.
• Ask the ophthalmologist to warn you before doing the injection.

How Often to Have Eye Injections

You will need to receive eye injections to control AMD periodically. Initially, most people can expect to get anti-VEGF injections once a month, although some agents last longer than others.

In some cases, you may get these less often over time and may even eventually be able to stop. But for others, the need for such eye injections to keep abnormal blood vessels from forming and preserve vision will continue.

If you are receiving Syfovre injections, you will need these every 25 to 60 days.

Summary

Eye injections can help treat AMD and other conditions such as diabetic retinopathy and retinal vein occlusions. These can deliver a first-of-its-kind drug, Syfovre, for combating geographic atrophy, anti-VEGF medication, and drugs to fight infection and inflammation.

While it's natural to have concerns about eye injections, the use of numbing drops keeps discomfort to a minimum. The injections themselves can slow AMD, as well as geographic atrophy, and help to preserve vision.