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We are very fortunate to live in an era in which, through intravitreal injections, we can offer a treatment to patients we diagnose with macular degeneration. Until a few years ago, when we saw a patient in the early stages of macular degeneration, unfortunately all we could do was explain how the disease would progress, which in most cases meant a large scar in the macula with permanent loss of central vision. It took between one and six months for vision to fall to these very low levels. That was the case until a few years ago, when it was observed by chance that a medicine belonging to the class of anti-VEGF (anti-angiogenic) drugs significantly improved vision in people with the wet form of macular degeneration. The revolution this observation brought to the treatment of the condition was enormous.
Since then, studies have been carried out, and continue to be carried out, showing the huge difference in vision and in the clinical picture between patients treated with anti-VEGF and those who were not. Most studies showed that visual acuity, in other words how well the patient sees, improved significantly compared with their first visit to the clinic, that is, the day of diagnosis. Apart from the fact that we can improve the patient’s vision in the early stages of the condition, it is very important to stress once again that the outlook without treatment is very poor, and that the usual outcome was a large scar in the centre of the macula with very low vision.
Why do many patients with macular disease lose their sight?
First of all, there are several different macular conditions, and a significant proportion of them are not treated with intravitreal injections. So a correct diagnosis is a very important part of treatment.
Secondly, early diagnosis is very important because, of course, if the condition has been present for months before diagnosis, there may already be permanent damage.
The most important reason why someone may not get a good result, however, is incomplete treatment or treatment with ineffective protocols. In other words, there are cases in which critical time has been lost at some stage of the disease, with treatment given at longer intervals than ideal. As a result, the improvement gained from treatment is lost in the period until the next injection is given. So the condition is never brought under control.
Is there any point in continuing treatment if there is already extensive damage to the macula?
Of course, the part of the macula that has suffered permanent damage cannot be restored with current treatments. Treatment still makes sense, however, if our aim is to stop the area of lost vision from growing. In other words, the risk for a person with existing damage to the macula is that the damage will grow, and with it the area of poor vision. If the affected area is not particularly large, then it certainly makes sense to try to limit it. So it is more of a choice that differs for each person, and the right approach for us is to inform the patient and give them all the information they need to make the right decision for themselves.
Do intravitreal injections hurt?
The answer to this question is simple. It depends on the anaesthesia we use. There is a way to make it completely painless and, of course, even with the lightest form of anaesthesia, which is anaesthetic drops alone, most of the time the patient feels no pain, or any pain is very slight. Personally, I choose a combination of anaesthesia with which the patient usually feels no pain at all.
Are there risks with intravitreal injections?
Every procedure on the human body carries some risks. The intravitreal injection is no exception, but the risks are quite small. Statistics show that the chances of developing a haemorrhage, an infection or a retinal detachment are less than 1 in 1,000 cases, and my personal experience shows that these rates are considerably lower. Of course, the setting and the procedure followed during an intravitreal injection also play an important part. With experience of more than 1,500 intravitreal injections, we keep the area completely sterile, and the injection itself is given in a way that maximises patient safety. It is both the setting and the technique that ensure the safest possible result.
Frequently Asked Questions about Intravitreal Injections
Does the eye injection hurt?
Most patients describe the injection as less unpleasant than they expected. Before the procedure the eye is numbed with drops or gel, so you mainly feel a brief pressure. Once the anaesthetic wears off, there may be a gritty or burning sensation for a few hours to a day.
How often are intravitreal injections given?
Treatment usually starts with one injection a month for the first few months. After that, the interval is adjusted individually based on the OCT findings and vision, and in many patients it is gradually extended to two, three or more months. The frequency depends on the disease, the medicine and how the eye responds.
What are the risks of intravitreal injections?
The injections are considered safe when performed under sterile conditions. A red patch on the white of the eye and temporary discomfort are common and harmless. Serious complications, such as endophthalmitis, raised eye pressure, a retinal tear or retinal detachment, are rare. Reporting any symptoms promptly after the injection allows immediate treatment.
Which conditions are treated with intravitreal injections?
Intravitreal injections are mainly used for wet macular degeneration, diabetic macular oedema, macular oedema after retinal vein occlusion and choroidal neovascularisation due to high myopia. In some cases they are also used for inflammation inside the eye or for selected macroaneurysms.
Questions about your case?
Dr. Skouteris will examine you at his practice in Neo Psychiko and explain your options.
Ophthalmic surgeon trained at the John Radcliffe University Hospital in Oxford and Fellow of the European Board of Ophthalmology (FEBO).
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