By Erin B. Lally, MD – Board‑Certified Ophthalmologist
If your optometrist or ophthalmologist has mentioned “anti‑VEGF injections,” you may have a lot of questions. Here you will learn what anti-VEGF drugs are, how they work, the conditions they treat, and what to expect from your treatment. I’ve also included an FAQ section and a checklist of symptoms that should prompt you to schedule an eye examination.
What Is Anti‑VEGF?
VEGF stands for “vascular endothelial growth factor.” It is a naturally occurring protein that tells your body to grow new blood vessels.
VEGF is beneficial in normal situations, like wound healing or restoring blood flow after an injury. But too much VEGF inside the eye can be dangerous. Excess VEGF causes abnormal, fragile and leaky blood vessels to grow beneath or within the retina. This leakage leads to swelling, bleeding, and scarring that can quickly damage the cells that give us vision.
Anti‑VEGF medications are biological agents (either antibodies or antibody fragments) that neutralize VEGF before it can exert these harmful effects. By blocking VEGF, the drugs reduce leakage, shrink abnormal vessels, and stabilize, or even improve, vision.
How Do Anti‑VEGF Injections Work?
Think of anti‑VEGF medicine as a sponge that soaks up excess VEGF in the eye:
- Targeted Action – The medication binds specifically to VEGF molecules floating in the eye’s fluid.
- Rapid Impact – Once VEGF is neutralized, abnormal vessels begin to regress and fluid is re‑absorbed.
- Ongoing Protection – Because the eye continuously produces VEGF, repeated injections are needed to keep levels low.
Several anti‑VEGF drugs are in common use today:
| Generic Name | Brand Name | FDA‑Approved Uses* |
|---|---|---|
| Ranibizumab | Lucentis® | AMD, DME, RVO, mCNV |
| Aflibercept | Eylea® | AMD, DME, RVO, mCNV |
| Brolucizumab | Beovu® | AMD |
| Faricimab | Vabysmo® | AMD, DME |
| Bevacizumab† | Avastin® | Widely used off‑label |
*AMD = Age‑related Macular Degeneration | DME = Diabetic Macular Edema | RVO = Retinal Vein Occlusion | mCNV = myopic Choroidal Neovascularization
†Bevacizumab is FDA‑approved for cancer treatment but has been safely repurposed for ocular use for more than 15 years.
What Conditions Are Treated With Anti-VEGF Treatments?
- Wet (Neovascular) Age‑related Macular Degeneration – Abnormal vessels grow under the macula, causing rapid loss of central vision.
- Diabetic Macular Edema & Proliferative Diabetic Retinopathy – Long‑standing diabetes increases VEGF, leading to swelling and bleeding in the retina.
- Retinal Vein Occlusions – A blocked retinal vein elevates VEGF levels, producing fluid buildup and blurred vision.
- Myopic Choroidal Neovascularization – Very high (pathologic) myopia can trigger VEGF‑driven vessel growth beneath the retina.
- Other Less Common Conditions – Radiation retinopathy, inflammatory CNV, and ROP (in premature infants) may also respond to anti‑VEGF therapy.
What To Expect During An Anti-VEGF Injection Appointment
The word “injection” understandably makes many patients nervous, but the procedure is quick and virtually painless. The entire visit typically lasts 10-15 minutes, with the actual injection taking under 10 seconds. Most patients resume normal activity the same day.
- Topical Anesthetic & Antiseptic – Topical numbing drops prevent discomfort, and a gentle iodine solution is used to sterilize the surface of the eye.
- Eyelid Retractor (Speculum) – A small device keeps your eyelids open so you can’t blink at the critical moment.
- Precise Delivery – Using a tiny 30 gauge needle, I place a precise dosage of medication into the vitreous cavity (the gel in the back of the eye).
- Pressure Check & Lubrication – I confirm that eye pressure is stable and give soothing drops to minimize post‑injection irritation.
Will I Need Anti-VEGF Treatments for Life?
It depends on the underlying diagnosis and your individual response.
Wet AMD often requires long‑term, sometimes lifelong, maintenance injections—though intervals can usually be stretched once the retina is dry and stable.
Diabetic Macular Edema may calm down after a series of monthly doses; some patients transition to occasional “booster” injections or switch to laser therapy.
Vein Occlusions frequently quiet within 6-12 months but a minority of eyes need ongoing therapy.
We evaluate three key factors at every visit: retinal fluid on OCT scan, visual acuity, and your comfort level. If the macula remains dry for several visits, we lengthen the interval by 2‑4 weeks at a time. My goal is to find the *longest* safe gap between injections without allowing fluid to re‑accumulate.
Frequently Asked Questions About Anti-VEGF Treatments
Do Anti-VEGF Injections Hurt?
You’ll feel slight pressure but, thanks to numbing drops, most patients rate discomfort 1–2 on a 10‑point scale – far less than a blood draw.
What Are the Side Effects of Anti-VEGF Injections?
Mild scratchiness or a “floaty” bubble is common for 24–48 hours. Serious complication, such as infection (1 in 3,000) or retinal detachment (<1 in 10,000), are rare and treatable when caught early.
Will Anti-VEGF Treatments Improve My Vision?
Roughly one‑third of patients gain significant vision, one‑third stabilize, and one‑third experience gradual decline. Even when improvement is modest, injections help preserve reading and driving vision longer than observation alone.
What Are The Alternatives To Anti-VEGF Treatments?
For certain diabetic cases, retinal laser or steroid implants are options. Emerging long‑acting implants and gene therapies aim to reduce injection frequency, but anti‑VEGF remains the gold standard today.
Can I Stop Anti-VEGF Treatments If My Vision Seems Fine?
The absence of symptoms doesn’t always equal a healthy macula. We rely on OCT imaging to guide decisions. Stopping prematurely can allow silent fluid to build and cause irreversible damage.
Vision Symptoms That Require an Urgent Eye Exam
If you notice any of the symptoms below, contact me or your ophthalmologist right away to schedule an eye exam.
- Sudden Distorted Vision: If you experience sudden changes in your vision, such as distorted or blurred vision, contact your eye doctor immediately.
- New Dark Patch: A new dark patch in your vision can be a sign of a serious issue and should be evaluated promptly.
- Rapid Vision Decline: If your vision worsens rapidly, seek medical attention right away.
- Straight objects appearing bent or broken
- Flashes and Floaters: Persistent flashes of light or an increase in floaters can indicate a problem and should be checked by an eye specialist.
Key Takeaways About Anti-VEGF Treatments
- Anti‑VEGF drugs block the protein that causes leaky, sight‑threatening vessels.
- Anti-VEGF injections are administered safely in‑office and take seconds to deliver.
- Conditions treated include wet AMD, diabetic eye disease, vein occlusions, and high‑myopia complications.
- Treatment frequency is customized, many patients eventually extend to 8–12‑week intervals.
- Regular follow‑up and imaging are essential, even when your vision feels normal.
Protecting sight is a partnership.
By staying informed and engaged, you give yourself the best chance of maintaining clear, comfortable vision for years to come. If you have questions about anti‑VEGF therapy, or any eye concern, please reach out. My team and I are here to help!
