Anti-VEGF treatment is a way to slow vision loss in people who have a condition known as “wet” age-related macular degeneration (AMD).
Researchers have found that a chemical called vascular endothelial growth factor, or VEGF, is critical in causing abnormal blood vessels to grow under the retina. Scientists have developed several new drugs that can block the trouble-causing VEGF. These are referred to as “anti-VEGF” drugs, and they help block abnormal blood vessels, slow their leakage, and help reduce vision loss.
Treatment with the anti-VEGF drug is usually performed by injecting the medicine with a very fine needle into the back of your eye. Prior to injection, Dr Hillson will clean your eye to prevent infection and will administer an anesthetic into your eye to reduce pain. Usually, patients receive multiple anti-VEGF injections over the course of many months. In 95% of patients receiving these injections, further vision loss is arrested. About 40% of AMD patients experience visual improvements with these injections, with some patients gaining significant amounts of vision. Complications with this procedure are rare, but include retinal tear (1%) and infection (0.1%). For most people, the benefits of this treatment outweigh the small risk of complications. Anti-VEGF medications are a step forward in the treatment of wet AMD because they target the underlying cause of abnormal blood vessel growth.
Lucentis is the preferred anti-VEGF drug in the treatment of “wet” AMD, as it has been developed and tested and proven safe and effective for use in the eye specifically. Lucentis is covered by OHIP for patients over 65 years of age who have developed wet AMD and who are not receiving photodynamic therapy. Following patients being treated with anti-VEGF drugs require special OCT testing; OCT testing is covered by OHIP. Patients require an average of six to nine treatments per year, at minimum four week intervals.
Some patients with other retinal diseases or those under the age of 65 may benefit from anti-VEGF injections but do not qualify for OHIP coverage of Lucentis injections. Lucentis injections for those patients without coverage are expensive at $1700 per injection. Some drug plans will cover or partially cover this cost. For those patients without coverage or with partial coverage, another option is an anti-VEGF drug named Avastin (bevacizumab) that is similar to Lucentis in its effect but much less expensive. Avastin is an anti-VEGF is a drug that was developed for the treatment of colorectal cancer. The use of Avastin as a treatment for macular degeneration is consider “off-label”, or outside the recommended usage parameters of the drug. Avastin has not been studied for use in the eye as carefully as Lucentis, and some risks and negative effects may exist that have not yet been documented. However, thousands of patients around the world without access to Lucentis, including many in my own practice, have safely experienced significant visual preservation and restoration with Avastin treatments. Avastin injections cost $50 each versus $1700 each for Lucentis. Avastin is prepared for injection in the eye by a special pharmacy and all Dr Hillson’s Avastin injections are performed at the office on West Street. With either drug patients require an average of six to nine treatments per year at four to six week intervals, as well as OCT testing.
