Injections

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Injections

For many conditions affecting the retina and its neighboring components, injections are an effective treatment option. They allow doctors to deliver higher medication doses to specific eye parts, and generally, with fewer side effects, pain, and discomfort. Not surprisingly, injections are the most commonly performed ophthalmic procedure in the United States.

Why And How Are Eye Injections Administered?

Compared to other common eye and vision treatments, such as eye drops, injections allow doctors to precisely deliver higher doses of medications to specific parts and areas of the eye, even those difficult to access. Injections may also protect patients, partially or completely, from the potentially harmful side effects of pills or systemic medications. In addition, this method typically results in little or no pain or discomfort.

What Are The Benefits Of Injecting Into The Vitreous?

In most cases, injections are administered in the vitreous — also called the vitreous gel or humor — the clear, jelly-like liquid that fills 80% of the eye’s volume. The vitreous has two main responsibilities: 1. It supports the eye’s structure; 2. It provides an unobstructed pathway for light entering the lens to reach the retina, enabling you to see.

When administered directly into your vitreous, medications gain the access required to enable rapid absorption into the retina. As a result, you can be given smaller drug dosages, compared to oral or intravenous delivery.

What Are Anti-VEGF Medications?

The majority of injections administer anti-vascular endothelial growth factor (anti-VEGF) medications. They can be given to slow abnormal blood vessel growth or prevent blood vessels from leaking fluid into the eye. The most well-known anti-VEGF medications include Avastin® (bevacizumab), Lucentis® (ranibizumab), and Eylea® (aflibercept).

Anti-VEGF medications are considered the standard treatment for multiple diseases impacting the retina and its central part, the macula, which enables central, close-up vision, and such activities as reading or seeing faces. These conditions include:

• Wet age-related macular degeneration (wet AMD)
• Proliferative diabetic retinopathy
• Central retinal vein and artery occlusions (CRVO and CRAO)
• Branch retinal vein and artery occlusions (BRVO and BRAO)
• Diabetic macular edema

What Is Neovascularization?

These conditions are similar in that they all develop through the process of neovascularization. It involves the body producing new retinal blood vessels to replace those lost to disease or injury. These new vessels may be abnormal and fragile, cutting off the steady supply of oxygenated blood to the retina or vascular tissue. Blood and vitreous can also leak into the retina. But anti-VEGF medications inhibit the proteins that lead to new blood vessel growth.

Neovascularization Symptoms

Among the symptoms you may experience with neovascularization are eye floaters, hazy vision, edema (swelling), and problems with night vision and Iighting changes.
Should these symptoms worsen, you may develop such complications as permanent blindness, eye loss, and retinal tears or detachment.

What To Know About Anti-VEGF Injections

If your ophthalmologist decides anti-VEGF medications are needed, here is what you should know to prepare yourself.

• An in-office procedure, injections usually take about 10-15 minutes to perform.
• While injections impart little to no discomfort or pain, the retina specialist will administer a local anesthetic, often eye drops, to numb and prevent pain. A cotton swab with concentrated lidocaine will then be applied.
• Your eyes will be cleaned with an antiseptic to prevent bacterial infection.
• The retinal specialist will keep your eyelid open with their fingers or a speculum, a medical instrument enabling viewing of the eye’s interior hollow parts.
• A very thin needle will inject medication into your sclera, the eye’s white part. You’ll be asked to look in the opposite direction. You may feel slight pressure when injected.

Repeat injections, possibly monthly, may be necessary to maintain eye health and optimize vision, especially with chronic conditions, like AMD and diabetic retinopathy. The retina specialist will discuss your long-term treatment options during the prior exam. Afterward, depending on the condition, you may experience vision improvement.

Potential Injection Side Effects

You may experience certain side effects with eye injections, but generally, these are temporary and are treated with eye drops. The more common side effects include:

• Pain or scratchy sensations
• Conjunctival hemorrhage, which is bleeding on the white of the eye
• Floaters
• Increased eye pressure
• Eye inflammation or bruising

Less often, you may develop such side effects as infection, bleeding or redness in the eye, retinal tears or detachment, lens damage, and cataract formation.