Anti-VEGF injections in Eyecare

Anti-VEGF (vascular endothelial growth factor) injections are commonly used in eyecare for several retinal conditions. The indications for anti-VEGF injections and the prognosis associated with their use can vary depending on the specific condition being treated. Here are some common indications and the associated prognosis: 1. Age-Related Macular Degeneration (AMD): Anti-VEGF injections are a standard treatment for neovascular or "wet" AMD, which is characterized by the growth of abnormal blood vessels in the macula, the central part of the retina. The prognosis for wet AMD has significantly improved with the introduction of anti-VEGF therapy. In many cases, anti-VEGF injections can slow down or halt the progression of the disease, leading to stabilization or improvement in vision. 2. Diabetic Retinopathy: Anti-VEGF injections are used in the treatment of diabetic retinopathy, particularly in cases where there is the presence of diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR). The prognosis for diabetic retinopathy depends on the severity of the disease and the response to treatment. Anti-VEGF injections can help reduce macular edema, improve vision, and prevent further progression of the disease in many cases. 3. Retinal Vein Occlusion (RVO): Anti-VEGF injections are commonly used in the treatment of macular edema associated with retinal vein occlusion. The prognosis for RVO depends on various factors, including the duration and severity of the occlusion, the presence of macular edema, and the response to treatment. Anti-VEGF injections can help reduce macular edema, improve vision, and prevent complications such as neovascularization and macular ischemia. 4. Other Retinal Conditions: Anti-VEGF injections may also be used in the treatment of other retinal conditions, such as myopic choroidal neovascularization (CNV) and retinal angiomatous proliferation (RAP). The prognosis for these conditions can vary depending on the specific characteristics of the disease and the response to treatment. Anti-VEGF injections can help reduce abnormal blood vessel growth, improve vision, and prevent further complications. It is important to note that the prognosis for each individual patient can vary depending on various factors, including the stage and severity of the disease, the presence of other ocular or systemic conditions, and the overall health of the patient. Regular monitoring and follow-up visits with an Eye Specialist are essential to assess the treatment response and adjust the treatment plan as needed. Early detection, prompt treatment, and adherence to follow-up care can significantly improve the prognosis for patients receiving anti-VEGF injections in eyecare.

Types of anti-VEGF injections:

1. Ranibizumab (Lucentis): Ranibizumab is an FDA-approved anti-VEGF medication that is widely used in the treatment of retinal conditions such as wet age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO). It is administered as an intravitreal injection and works by inhibiting the action of VEGF, thereby reducing abnormal blood vessel growth and improving retinal health. 2. Aflibercept (Eylea): Aflibercept is another FDA-approved anti-VEGF medication used in the treatment of wet AMD, DME, and RVO. It is also administered as an intravitreal injection. Aflibercept works by binding to and neutralizing VEGF, preventing its interaction with receptors on blood vessels and reducing the growth of abnormal blood vessels in the retina. 3. Bevacizumab (Avastin): Bevacizumab is an anti-VEGF medication that is commonly used off-label in eyecare. Although it is FDA-approved for the treatment of certain cancers, it has been found to be effective in the treatment of retinal conditions such as wet AMD, DME, and RVO. Bevacizumab is administered as an intravitreal injection and works by inhibiting VEGF activity.

4. Vabysmo/ Faricimab has an inhibitory effect on both VEGF-A and Ang-2 and is thought to have a longer-lasting effect than previous anti-VEGF agents.

Anti-VEGF therapy has been employed in the treatment of retinal vascular disease, however, its effectiveness is limited by the role of VEGF in pathogenesis.

The anti-VEGF-A effect

• inhibits endothelial proliferation,
• reduces vascular permeability, and
• suppresses neovascularization.

Exploration of alternative targets has revealed the role of angiopoietin (Ang), whose two isoforms Ang-1 and Ang-2 bind to tyrosine kinase (Tie-2) endothelial receptors to regulate vasculogenesis.Ang-1 is an agonist of Tie-2 with constitutive vessel-stabilizing effects, but Ang-2 is an antagonist which inhibits its phosphorylation and has been shown to play a role in cytokine-induced vascular leakage. The anti-Ang 2 effect is thought to

• improve vascular stability and
• desensitize the vessels to the actions of VEGF-A.

It is important to note that while these are the most commonly used anti-VEGF injections in eyecare, the availability and use of specific medications may vary depending on factors such as country-specific regulations and healthcare practices. The choice of anti-VEGF injection may be determined by the treating Specialist based on factors such as the patient's condition, response to treatment, and individual considerations.

Ant-VEGF's do not modify the course of disease but work to reduce exudation and further, need frequent adminstration.

Author

Paddy Kalish OD, JD and B.Arch