What medications are used to treat wet AMD?

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There are effective medications for treating the wet form of age-related macular degeneration (AMD). Various drugs can at least improve vision temporarily or help to maintain it for longer.

In wet AMD, new blood vessels grow underneath the . They grow into the retina and may lift it up. The new blood vessels may also become “leaky,” allowing blood and fluid to seep into the , where it damages the area we need for central vision.

Certain medications can slow the growth of new blood vessels at the back of the eye. They are called VEGF (vascular endothelial growth factor) inhibitors, and are supposed to slow or at least temporarily stop the progression of the disease. But this treatment is not a cure.

The following medications have been approved for the treatment of wet AMD:

  • Aflibercept (trade name: Eylea)
  • Brolucizumab (trade name: Beovu)
  • Ranibizumab (trade name: Lucentis)

The drug bevacizumab (Avastin) is also used. But it has been approved for cancer treatment, and not for the treatment of AMD. If doctors prescribe it for AMD, they have to prescribe it “off-label” (see final section below).

There is currently no effective treatment for dry macular degeneration.

How is the medication used?

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. For Lucentis, the number of injections needed and the amount of time between injections will depend on how the AMD progresses. Regular eye exams and eye tests are done to check up on this. Eylea is injected every two months after the first three months of treatment. After one year, the treatment will also be continued depending on how the condition develops.

How effective are these medications?

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.

What are the possible side effects?

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 inside the eye (endophthalmitis) or in the uvea (one of the layers of the eye's surface), cataracts or damage.

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.

Off-label: Avastin for treating age-related macular degeneration

As mentioned above, Lucentis and Eylea have been approved for the treatment of macular degeneration, but Avastin has only been approved for cancer treatment. The active ingredients in Avastin und Lucentis are very similar, though. Several studies have shown that Avastin is just as effective as Lucentis in treating wet AMD. Their side effects are also similar.

Because Avastin costs quite a lot less than Lucentis 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's important to check with your insurer beforehand.

Li J, Xu J, Chen Y, Zhang J, Cao Y, Lu P. Efficacy Comparison of Intravitreal Anti-VEGF Therapy for Three Subtypes of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis. J Ophthalmol 2018; 2018: 1425707.

Low A, Faridi A, Bhavsar KV, Cockerham GC, Freeman M, Fu R et al. Comparative effectiveness and harms of intravitreal antivascular endothelial growth factor agents for three retinal conditions: a systematic review and meta-analysis. Br J Ophthalmol 2019; 103(4): 442-451.

Moja L, Lucenteforte E, Kwag KH, Bertele V, Campomori A, Chakravarthy U et al. Systemic safety of bevacizumab versus ranibizumab for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2014; (9): CD011230.

Nguyen CL, Oh LJ, Wong E, Wei J, Chilov M. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration: a meta-analysis of randomized controlled trials. BMC Ophthalmol 2018; 18(1): 130.

Sarwar S, Clearfield E, Soliman MK, Sadiq MA, Baldwin AJ, Hanout M et al. Aflibercept for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2016; (2): CD011346.

Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2014; (8): CD005139.

Thulliez M, Angoulvant D, Pisella PJ, Bejan-Angoulvant T. Overview of Systematic Reviews and Meta-analyses on Systemic Adverse Events Associated With Intravitreal Anti-Vascular Endothelial Growth Factor Medication Use. JAMA Ophthalmol 2018; 136(5): 557-566.

Ueta T, Noda Y, Toyama T, Yamaguchi T, Amano S. Systemic vascular safety of ranibizumab for age-related macular degeneration: Systematic review and meta-analysis of randomized trials. Ophthalmology 2014; 121(11): 2193-2203.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on January 28, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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