New treatments for wet AMD have transformed the outlook for patients with this condition. These involve the injection of a highly specialised and targeted medicine into the gel-like fluid of the eye (the vitreous). The drug works by blocking the protein responsible for the growth of fragile blood vessels which grow under the retina in wet AMD. This protein is called vascular endothelial growth factor (VEGF), and the medicines used are called anti-VEGF agents.
Different types of anti-VEGF agents are available, and Mr Patel can discuss the best treatment for you during the consultation. Studies have shown that repeated and regular anti-VEGF injections are effective in preventing blindness and can stabilise vision in patients with wet AMD. Injection treatments don’t work if you are unable to have regular injections or if you fail to attend for regular follow-up consultations. The interval between anti-VEGF injections and the length of time you will need treatment for will depend on the severity of the condition and how you respond to the treatment.
Currently, there are three different types of anti-VEGF medicines which are commonly used to treat wet AMD. These are Eylea, Lucentis or Avastin. Mr Patel will discuss which of these treatments is most appropriate for you after a detailed consultation and with appropriate retinal imaging tests.
If injection treatment is appropriate, Mr Patel will further discuss how he gives the treatment. He performs eye injections in a clean minor treatment room and asks patients to recline comfortably on a couch as a first step.
Next, he will numb the eye receiving the injection with strong anaesthetic eye drops and iodine drops to clean and wash the eye and eyelids on the side of the injection. Next, he places a clean, sticky plastic drape or sheet over the eye to keep the procedure sterile. He positions a metal clip to hold the eyelids open before the injection. Further, he applies anaesthetic and iodine drops before the injection.
Finally, Mr Patel will ask you to look in a particular direction, away from the site of the injection to keep the eye in the best position ready for the injection. It takes seconds to perform the injection itself. Immediately after the injection, you may notice be a swirling or smoky pattern in the vision and a few dark circles floating in the vision. These symptoms generally settle over a few hours though patients can report an increase in floaters if they have had many injections carried out.
At the end of the injection, Mr Patel will wash out the iodine and will put a lubricating tear drop into the eye to help keep the eye comfortable after the anaesthetic drops wear off. He will give you a bottle of lubricating tear drops, and you can use these every hour or two on the day of the injection and then for 4 or 6 times a day for 4 or 5 days after the injection, or until the eye becomes comfortable.
You can then go home. It’s important to make sure you have a further appointment for the next injection or assessment as regular treatment offers the best prospect of stabilising or improving the vision in the long-term.