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Treatment of Wet Age-Related Macular Degeneration (AMD)

September 2023

We get questions about how the treatments for neovascular, or wet, AMD are given. In this newsletter we will discuss the basics of treatment. It is not meant to apply to any one case or all cases, and the specifics of any treatment should be discussed with your doctor.

The treatment of wet AMD today involves some form of delivering treatment to the center of the eye, called the vitreous or vitreous cavity; thus what is termed intra-vitreal delivery. Today there are two forms of intra-vitreal drug delivery. One form is injection of the medication into the vitreous with a small needle, and the other is an intravitreal surgically implanted reservoir that will need to be refilled after a certain amount of time. Today, we will only discuss the needle injection. The injection into the vitreous cavity is typically repeated at some interval.

The intra-vitreal needle injection is done in the office after administering topical anesthesia to the eye with one or more drops, and/or after a local anesthetic is injected around the eye. In addition, a special antiseptic solution that has been shown in previous studies to decrease the amount of germs on the surface of the eye is used on the eye prior to the injection of wet AMD treatment to decrease any risk of post-operative infection. Due to the very small size of the needle used for wet AMD treatment, there is typically no pain associated with the injection. However, some patients will be aware that there is a pushing sensation on the eye when the injection is done. Some patients, after the anesthetic has worn off, will have a mild irritating sensation in the eye due to the drop or drops used and some doctors will advise the use of artificial tears which often will make these symptoms better.

There are usually no specific things that you need to do after the injection. However, all instructions, both before and after an injection, and discussion of risks and benefits, will need to come from your doctor.

We also wanted to share the perspective of some of our ForeseeHome patients, who have converted to wet AMD in one or both of their eyes, as to what the experience of getting injections is like for them.

Raymond tells us about his first injection for wet AMD: “The idea that anyone would come near my eye with a needle was terrifying but my mother was legally blind due to wet AMD so I knew I had to get treatment.

Before my appointment a friend comforted me with his own wet AMD injection experience, and I had faith in his words that my eye would be numb, and I wouldn’t experience pain.

My doctor was very good at explaining everything that was happening. I did not feel pain but more so pressure and the injection took only a few seconds.
Now I've had injections so many times it's become very routine. It’s not too bad at all, just like my friend said.”

Dale explains the injection process and his treatment experience: “Of course, I was scared because it’s a needle going into your eye.

At my first appointment there were multiple drops administered for cleaning and numbing. A metal screen-like device was used to hold my eye open so I would not instinctively blink. I did feel a bit of pressure with the injection, but it was not painful. I wore an eye patch on my treated eye for protection. I also arranged to have someone drive me as I thought it would be difficult to drive with the patch.

For my second injection, I had less anxiety because the first injection went so well. I’m now able to extend treatments and do not need to go monthly so I’d say any anxiety and minimal discomfort is well worth it. I am very happy with the results and would encourage anyone who is told they need injections for wet AMD to know it is not that bad and worth saving your eyesight.”

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