From the Guidelines
VEGF inhibitors like Lucentis (ranibizumab) and Eylea (aflibercept) can effectively delay wet AMD progression indefinitely with ongoing treatment, rather than for a specific time period. These medications require regular intravitreal injections, typically starting with monthly treatments for three consecutive months (loading phase), followed by individualized maintenance schedules ranging from every 4-12 weeks based on disease activity, as supported by the most recent study 1. The effectiveness of these treatments varies between individuals, with some patients achieving disease stabilization with less frequent injections while others require more regular treatment.
Key Considerations
- The treatment approach may involve a "treat and extend" protocol, where the injection interval is adjusted based on the patient's response to treatment, as discussed in 1 and 1.
- Regular monitoring with OCT imaging is essential to assess treatment response and determine optimal injection intervals, allowing for adjustments to be made as needed to maintain vision and prevent disease progression.
- The risks and benefits of treatment, including potential complications such as endophthalmitis, noninfectious inflammation, retinal tear, or detachment, should be discussed with the patient and informed consent obtained, as noted in 1.
Treatment Outcomes
- Studies have shown that VEGF inhibitors can improve visual acuity-related outcomes, including the likelihood of visual acuity gain and less than 15 letters of visual acuity loss, as reported in 1.
- The choice between different VEGF inhibitors, such as ranibizumab and aflibercept, may depend on individual patient factors and disease characteristics, with aflibercept being noninferior to ranibizumab in terms of visual acuity outcomes, as found in 1.
Long-Term Management
- Most patients require long-term therapy, often for many years or even lifelong, as permanent discontinuation frequently leads to disease reactivation and vision loss, highlighting the importance of ongoing treatment and monitoring.
- The use of AREDS/AREDS2 supplements may be recommended for patients with unilateral disease to reduce the risk of developing advanced AMD in the fellow eye, as suggested in 1.
From the Research
Progression of Wet AMD and Delayed Progression with VEGF Injections
- The progression of wet Age-related Macular Degeneration (AMD) can be slowed down with the use of Vascular Endothelial Growth Factor (VEGF) inhibitors, such as Lucentis (ranibizumab) or Eylea (aflibercept) 2, 3, 4.
- VEGF inhibitors work by stopping the growth of new blood vessels, preventing further damage to the macula and vision loss 5.
- The main goal of treatment with VEGF inhibitors is to inhibit choroidal neovascularization (CNV) and improve visual acuity (VA) 2, 3, 4.
- Clinical trials have shown that ranibizumab and aflibercept can improve VA by 6 to 12 letters from the baseline VA of 50-65 letters and maintain the VA improvement regardless of the treatment regimen 6.
- The improvement in VA is rapid during the first month and becomes slower after the second injection, with 60% to 90% of the VA improvement attained within the first 3 months 6.
Duration of Delayed Progression with VEGF Injections
- The duration of delayed progression with VEGF injections varies depending on the treatment regimen and the individual patient's response to treatment 3, 4, 6.
- Monthly injections of ranibizumab have been shown to be effective in slowing down the progression of wet AMD, with some studies suggesting that less frequent dosing may be equally effective 3, 4.
- A treat-and-extend regimen, where the treatment interval is extended based on the patient's response, may be optimal for treating wet AMD and minimizing the risk of complications such as macular atrophy 6.
- The minimum number of injections required to improve and maintain VA varies depending on the individual patient's response to treatment, with some studies suggesting that 3-6 months of treatment may be sufficient to achieve maximum VA improvement 6.