ANTI-VEGF THERAPY

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What is VEGF?

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VEGF is short for vascular endothelial growth factors. This is a protein that encourages the growth of new blood vessels. However, when it is produced in the eye, it promotes the growth of abnormal blood vessels beneath the retina in the choroid. VEGF also increases the permeability of existing blood vessels, which means they have an increased risk of leaking. When the abnormal blood vessels leak, it causes swelling. This can cause damage to the retina resulting in vision loss.

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How does anti-VEGF therapy work?

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Anti-VEGF drugs work by blocking VEGF and minimizing its effects. Although VEGF can be beneficial in other parts of the body to promote healing and blood vessel formation, it is problematic when overproduced in the eye.  The most effective way to minimize VEGF in the eye is an injection directly into the eye, minimizing the effects on the rest of the body. Anti-VEGF drugs inhibit VEGF by binding or trapping it, preventing it from promoting the growth of new abnormal blood vessels. Synthetic nucleic acid or protein molecules called aptamers have been designed to bind VEGF and prevent it from exerting downstream effects.  It is important to know that anti-VEGF injections will not cure your disease but it can help preserve the vision you have and slow the progression of the disease.

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The most commonly used anti-VEGF drugs include:

• Avastin (Bevacizumab)

• Lucentis (Ranibizumab)

• Eylea (Aflibercept)

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Although Avastin was actually first developed for use in colon cancer, it is safe and often used off-label in the eye. All of these drugs have been shown to be effective for treating wet macular degeneration, diabetic macular edema, and macular edema caused by retinal vein occlusions. Each medicine has a slightly different structure, and they each work in a slightly different way.

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What are the possible side effects of anti-VEGF drugs?

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Side effects can vary depending on the specific treatment/drug you are taking. Most side effects of the therapy are related to the injection procedure itself rather than the drug. After the eye injection, you might have some discomfort, floaters, or foggy vision, and mild redness all of which should go away in a day or two.  Anti-VEGF therapy can cause increased intraocular eye pressure which may result in a patient needing to start on eye drops to help control the eye pressure.  They can also speed up the progression of cataract formation.  More serious complications of intraocular injections can include infection, retinal detachment, or bleeding inside the eye.  Sometimes, a small amount of bleeding over the white part of the eye may occur from a broken blood vessel. This is called a subconjunctival hemorrhage. While it looks serious, it will not affect your vision and often resolves on its own over several weeks.  A more permanent side effect can be tiny floaters caused by the silicone lining of the syringe used to administer the injection.  These are a nuisance but do not harm the eye and unfortunately, there is no treatment for them.  Keep in mind some people may experience side effects while others may not.

 

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