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Macular disease is the biggest cause of sight loss in the UK and age-related macular degeneration (AMD) is the most common type[i]. There are two types of AMD, known as ‘dry’ and ‘wet’[ii].

Wet AMD is a long-term, degenerative disease that can cause changes in vision, often experienced as gaps or dark spots in the centre of a person’s sight[iii]. Wet AMD can develop quickly and worsen over time[iii].If disease activity isn’t controlled, central vision will gradually get worse, leading to difficulty in everyday activities, such as reading, recognising faces and driving[iv].

To better manage disease progression, it is important to speak to your eye specialist as soon as you notice any changes in your vision and understand the treatment options available to you. It is also important to make the most of the time you get with your eye care team, so take this quick questionnaire and download your appointment guide. If you’re caring for someone with wet AMD, find out what to expect on treatment days and how you can best support them before, during and after appointments here.

Anti-VEGF treatment for wet AMD
Currently there are no medical treatments for dry AMD, although there are a few clinical trials underway. There are treatments available for wet AMD[v].

"There are treatments available for wet AMD."

Although there is no cure for wet AMD[vi], regular monitoring of fluid and blood in the back of the eye and consistent treatment could slow the progression of the disease. Additionally, lifestyle modifications could allow people living with the disease to remain independent for longer[vi].

In wet AMD, vascular endothelial growth factor (VEGF), a protein responsible for the development of healthy blood vessels, is over produced, causing abnormal blood vessels to grow and leak fluid and blood in the back of the eye[v]. Most eye specialists agree that the best way to reduce these proteins is with an anti-VEGF treatment – a treatment designed to reduce new blood vessel growth[v]. Anti-VEGF treatment reduce new blood vessel growth which helps 'dry' the retina and therefore may help slow the progression of wet AMD[vii].

Anti-VEGF treatments are injected into the eye[v]. While that might sound scary, the eye is numbed before the injection using anaesthetic eye drops, and many people who have gone through the treatment say the worry is worse than the procedure.

Every person responds differently to anti-VEGF treatment. The frequency of injections will be determined by your eye specialist, and based on the progression of your disease and presence of abnormal blood vessels at the back of your eye[viii]. There are a number of treatment regimens that your eye specialist can choose so ask them for the timescale between injections so that you can be sure not to miss any treatments. For more information on monitoring disease progression in wet AMD, click here.

While the frequency of injections may change over time, people with wet AMD and caregivers should expect long-term ongoing treatment, given the long-term, degenerative nature of this disease[ix].

Treatment day
On the day of your appointment, it’s normal to feel nervous about your treatment but here are some tips to help you feel more prepared. Some people have found the following techniques help them remain calm for appointments: 

  • Listen to music before your treatment.
  • Practice breathing exercises and relaxation techniques.
    • One good option is known as “equal breathing”: breathing in through the nose for a count of five, then breathing out for the same five, repeating several times[x].
  • If possible, try to schedule the appointment for early in the day, so there is less time to worry.
  • Ask your eye specialist if there are certain activities, such as driving or wearing contact lenses, that you should avoid after treatment.
  • Make sure you have pre-arranged travel or transport from the clinic back home.

During your appointment, your care team will[v],[xi]:

  • Clean your eye and the area around it, using a tool to gently hold the eye open.
  • Numb your eye before the injection by administering anaesthetic eye drops.
  • Ask you to look to one side and they will then give the injection in the opposite corner of the eye. You may feel some pressure, but you should not see the needle and it only takes a few seconds.
  • Provide you or your carer with information on how to care for your eyes after treatment.

Following the treatment, there are a few things to keep in mind: 

  • Expect to rest your eyes for at least a few hours.
  • Avoid getting water into your eyes for 48 hours[xii].
  • Make sure to follow any instructions from your healthcare professional, including which post-injection symptoms should be reported immediately.
  • Continue to use any eye drops prescribed for you.

Managing wet AMD through lifestyle choices
Diet and exercise are known to play an important role in general physical and emotional wellbeing. A healthy lifestyle is also important to improve your overall eye health. Some experts recommend a diet high in antioxidants or a dietary supplement, which are thought to potentially protect the eye and slow the progression of wet AMD[xiii].To learn more about the link between AMD and healthy living, click here.

In these exceptional times, hospitals and eye professionals are receiving regular guidance from The Royal College of Ophthalmologists as well as Public Health England to ensure everything possible is being done to make sure patients receive their eye injections in a safe environment.

Related Articles

Doctor and patient during appointment

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[i] Quartilho, A et al. Leading causes of certifiable visual loss in England and Wales during the year ending 31 March 2013. Eye vol. 30(4), 602-607. 2016.

[ii] American Academy of Ophthalmology. Have AMD? Save your sight with an Amsler grid. Available at: https://www.aao.org/eye-health/tips-prevention/facts-about-amsler-grid-daily-vision-test/. Last accessed January 2021.

[iii] Macular Society. Wet age-related macular degeneration. Available at: https://www.macularsociety.org/macular-disease/macular-conditions/wet-age-related-macular-degeneration/. Last accessed January 2021.   

[iv] NICE guidance. Age-related macular degeneration. Available at: https://www.nice.org.uk/guidance/ng82/chapter/Context. Last accessed January 2021.   

[v] Macular Society. Treatments. Available at: https://www.macularsociety.org/diagnosis-treatment/treatments/. Last accessed January 2021.

[vi] All about Vision. Macular degeneration: Prevention and risk factor reduction. Available at: https://www.allaboutvision.com/en-gb/conditions/amd-prevention/. Last accessed January 2021.

[vii] RNIB. Anti-VEGF treatment. Available at https://www.rnib.org.uk/eye-health/eye-conditions/anti-vegf-treatment. Last accessed January 2021.

[viii] Moorfields Eye Hospital. Patient Information: Anti-VEGF intravitreal injection treatment. Available at: https://www.moorfields.nhs.uk/sites/default/files/uploads/documents/Patient%20information%20-%20intravitreal%20injections%20for%20AMD.pdf. Last accessed January 2021.

[ix] Oxford University Hospitals. Treatment of age-related macular degeneration. Available at: https://www.ouh.nhs.uk/patient-guide/leaflets/files/13840Pmacular.pdf. Last accessed January 2021.

[x] Lin IM et al. Breathing at a rate of 5.5 breaths per minute with equal inhalation-to-exhalation ratio increases hear rate variability. International Journal of Psychophysiology. 2014;91(3):206-211.

[xi] BrightFocus Foundation. Injections for wet macular degeneration: What to expect. Available at: https://www.brightfocus.org/macular/article/injections-wet-macular-what-expect. Last accessed January 2021.

[xii] NHS Hull University Teaching Hospitals. Intravitreal injections. Available at: https://www.hey.nhs.uk/patient-leaflet/intravitreal-injections/. Last accessed January 2021.

[xiii] Macular Society. Nutrition. Available at: https://www.macularsociety.org/support/practical-guides/healthy-living/nutrition/. Last accessed January 2021.

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