What medications are used to treat wet AMD?

First, anesthetic eye drops are used to numb the eye. Then the doctor uses a thin needle to inject the actual drug into the eye. These injections are given at a doctor’s office as an outpatient procedure.

In the first three months, the medication is injected once a month. The number of injections needed and the amount of time between injections will depend on the specific medication that is used and how the AMD progresses. After that the injections can either be given according to a fixed treatment scheme (like every 1, 2 or 3 months) or the treatment can be designed to be more flexible. Regular eye examinations and vision tests are used to monitor the course of the disease.

These drugs are able to temporarily stop or at least delay loss of vision in many people who have wet AMD. Sometimes vision even improves again during treatment. They don't cure the disease, though. The various medications have a similar level of effectiveness.

In studies, the medications had a noticeable effect in a total of 40 out of 100 participants. After one year of treatment:

• Loss of vision had slowed in about 25 out of 100 people.
• Vision had even improved in about 15 out of 100 people.

The medications improved people’s quality of life, too. There is not yet enough research to know how the treatment affects the progression of AMD over the long term.

The injections may cause temporary (usually only mild) eye pain. Injecting fluid into the eyeball can raise the pressure inside the eye. Another common side effect is seeing spots or dots that follow the eye’s movements. These are caused by small air bubbles getting into the eye through the injections. These bubbles are not dangerous and go away on their own after one or two days.

Rare but serious side effects of the treatment may include inflammation inside the eye (endophthalmitis) or in the uvea (one of the layers of the eye’s surface), cataracts or retina damage. Recent studies suggest that using the medication once per month causes inflammation in the inside of the eye more frequently than if they are used less often.

Some studies suggest that the regular use of these medications may slightly increase the risk of developing conditions affecting the blood vessels in the brain, such as circulation problems, bleeding or strokes. No more than 1 out of 100 study participants experienced these side effects.

There is hardly any difference in side effects between the various medications.

As mentioned above, aflibercept, ranibizumab, brolucizumab and faricimab have been approved for the treatment of macular degeneration, but bevacizumab is approved only for cancer treatment. The active ingredients are very similar though, and they seem to have a similar effect in wet AMD. Their side effects are also similar.

Because bevacizumab (trade name: Avastin) costs less than the other medicines but is just as effective, some doctors prescribe it “off-label” for the treatment of AMD. A doctor who prescribes a drug for off-label use is required to provide additional information and instructions on this type of use. Statutory health insurers in Germany don’t have to cover the costs of off-label treatment, so it is important to check with your insurer beforehand.