✅ Medically reviewed by Dr Sharon Heng
Age-related macular degeneration (AMD) is a leading cause of vision loss in older adults. Wet AMD, characterised by abnormal blood vessel growth under the retina, requires effective treatment to manage its symptoms and prevent further vision deterioration.
Anti-VEGF (vascular endothelial growth factor) therapies have become a cornerstone in the AMD disease treatment landscape. This article explores the different anti-VEGF options available for treating wet AMD privately, providing insights into their effectiveness and application.
What Is Anti-VEGF Therapy?
Anti-VEGF therapy is designed to inhibit the activity of vascular endothelial growth factor, a protein that promotes the growth of abnormal blood vessels in the retina. These blood vessels can leak fluid and blood, leading to the vision loss characteristic of wet AMD. By blocking VEGF, these treatments help reduce fluid accumulation, improve vision, and stabilise the condition.
Common Anti-VEGF Medications
Several anti-VEGF medications are available for the treatment of wet AMD. Each has its unique properties and administration protocols:
Ranibizumab (Lucentis)
Ranibizumab was one of the first anti-VEGF drugs approved for wet AMD. It works by specifically targeting VEGF-A, the form of VEGF most involved in abnormal blood vessel growth. Patients typically receive an injection into the eye every 4 to 6 weeks. Ranibizumab has been shown to improve vision and reduce the risk of severe vision loss in many patients.
Aflibercept (Eylea)
Aflibercept is another popular option in the realm of AMD disease treatment. It binds to both VEGF-A and placental growth factor (PlGF), which are involved in abnormal blood vessel formation. Aflibercept is administered via an intravitreal injection. After an initial loading phase of usually 3x monthly injections, it may be extended to longer periods beyond 8 weeks.
It is known for its extended duration of action, which can reduce the frequency of injections. There are two different dosages available, 2 mg aflibercept and 8mg aflibercept which has recently been approved and has the advantage of lasting up to 16 weeks.
Bevacizumab (Avastin)
Originally developed for cancer treatment, bevacizumab is used off-label for wet AMD. It blocks VEGF-A and is generally less expensive than other anti-VEGF agents. Bevacizumab is typically administered every 4 to 6 weeks. Despite its off-label use, numerous studies have demonstrated its effectiveness in improving vision and stabilising AMD.
Faricimab (Vabysmo)
Faricimab (Vabysmo) represents a significant development in the treatment of wet age-related macular degeneration (AMD). Approved for this condition, it is a bispecific antibody that targets both angiopoietin-2 (Ang-2) and vascular endothelial growth factor-A (VEGF-A).
Laboratory studies show that these two proteins play a key role in the abnormal blood vessel growth and leakage that characterises wet AMD, leading to vision loss. In clinical trials, Faricimab demonstrated comparable efficacy to aflibercept, in maintaining or improving vision.
Importantly, Faricimab also has the potential for longer dosing intervals, with many patients achieving satisfactory results with injections every 16 weeks. Extended dosing intervals in newer anti-VEGF agents could greatly reduce the treatment burden on patients while maintaining effective control of the disease.
Comparing Effectiveness and Side Effects
Anti-VEGF therapies are very effective in treating and stabilising vision in patients in exudative or wet AMD. Ranibizumab, Aflibercept, and Vabysmo are all FDA and NICE approved specifically for wet AMD. Bevacizumab, is currently used off license.
Common side effects across all anti-VEGF treatments include eye discomfort, increased intraocular pressure, and risk of infection.
However, serious side effects or complications such as endophthalmitis or eye infections are rare. Each patient's response to treatment can vary, so it's essential to work closely with an eye care specialist to determine the most suitable option based on individual needs and medical history.
Choosing the Right Treatment
Selecting the best anti-VEGF therapy for wet AMD involves considering several factors:
Frequency of Injections
There are various different protocols for treatment depending on disease. PRN (Pronata) treatment protocol requires patients to be seen monthly and treated if necessary, TnE (Treat and Extend protocol) requires patients to be seen in an extended fashion and treated at every visit.
There are pros and cons with each protocol and is dependent on the severity of disease, progression of disease and patient’s preference. By and large, the longer acting therapies such as Aflibercept and Faricimab are designed to allow extended treatment strategies.
Cost
Cost can be a significant factor in private treatments. Bevacizumab is generally more affordable than ranibizumab and aflibercept. However, it's crucial to weigh the cost against the potential need for more frequent treatments. Your doctor will discuss the suitability of each treatment option with you.
Patient Preference
Personal preferences and lifestyle considerations also play a role in treatment choice. Some patients may prioritise fewer injections or have concerns about the cost of treatment.
Monitoring and Follow-Up
Regardless of the anti-VEGF medication chosen, ongoing monitoring and follow-up are crucial. Regular eye examinations and imaging tests, such as optical coherence tomography (OCT), help assess treatment effectiveness and adjust therapy as needed. Early intervention and consistent monitoring can significantly impact the success of AMD disease treatment and help preserve vision.
Conclusion
Anti-VEGF therapies are vital in managing wet AMD, offering patients the chance to maintain their vision and quality of life. With options like Ranibizumab, Aflibercept, Bevacizumab and Faricimab available, patients can work with their healthcare providers to choose the treatment that best fits their needs.
By understanding the differences between these medications and considering factors such as injection frequency, cost, and personal preference, individuals with wet AMD can make informed decisions about their treatment plan.
Regular monitoring and follow-up remain essential components of successful management, ensuring that treatment continues to be effective in combating the challenges of wet AMD.
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