Intravitreal injections are used to administer medications to treat a variety of retinal conditions. Age-related macular degeneration (AMD), diabetic retinopathy and retinal vein occlusion are the most common conditions treated with intravitreal anti-VEGF drugs.

Patients are often required to have intravitreal eye injections of anti-VEGF medications in order to treat diabetic macular edema, vein occlusion – either branch or central vein occlusion, or age-related macular degeneration.

There are three products that are used, and it is best that your surgeon determines which one will work best in your case. These drugs are injected in the office setting, with the patient having some topical anaesthesia, a speculum placed in their eye, and the drug placed into their eye by the doctor.

Patients who require intravitreal injections of anti-VEGF medication will learn that there are three basic drugs that are used at this point in time. One is bevacizumab, another is ranibizumab, and the third, by timeline, is aflibercept.

All three drugs are potent and effective. These three drugs have different capacities, and may be more indicated in a particular patient’s disease state. Your doctor will be the best person to determine which of these drugs most suits your needs.

Patients are often concerned that an injection of material into their eye will be a painful or scary procedure. In fact, after the first or second injection, patients become quite at ease with the idea that they will have these injections, and they are motivated by the fact that they do often see improvement of their visual acuity very quickly after these injections are started. 

When we as a retina community began to inject patients for diabetes, vein occlusion and macular degeneration, we thought this would be a one- or two-year process. The studies in fact were 24 months. Over time we’ve learned that in some cases we need to extend that period to many years. There are patients who will only need a few years of treatment, but many patients need lifelong monitoring, and in some cases, lifelong treatment with intravitreal injections.

Presenter: Dr. Michael Kapusta, Ophthalmologist, Montreal, QC

   Healthy eyes depend on regular visits to your optometrist for eye exams, and if necessary, an ophthalmologist for certain eye conditions and surgeries like diabetic retinopathy . You can also protect your eyesight with proper nutrition, eating foods that contain the right vitamins. Local Optometrists may prescribe eyeglasses and contact lenses, provide laser eye surgery consultations, and test for diseases.  Local Ophthalmologist  can help with many facts of eye diseases. Getting a referral from your optometrist to a local ophthalmologist is crucial to eye care.  

The risks of intravitreal injections are many, but fortunately, 99.9% of the time people do very well with the injections. They have good results, and they’re happy with the results. Sometimes there are risks, as with anything in life, there are risks. And they can be as extreme as blindness, but fortunately, that’s rare. For those that can’t have intravitreal injections, for example in pregnancy are not recommended. For those people it is better then to have laser treatment.

That was the standby treatment—or that was the main treatment in the past. It is the backup treatment even now, in addition to the injections, and is an excellent alternative to the injections.

The third option is to have what is called vitrectomy surgery, which is a true surgery in the operating room. But that is reserved now for extreme cases of diabetic retinopathy that can’t be handled in the office by such things as injections and lasers.

Presenter: Dr. Amit Gupta, Ophthalmologist, Scarborough, ON

Now Health Network Local Practitioners: Ophthalmologist

In regards to the frequency of injections and length of treatment, initially, the treatments start out being monthly. And over time, as your eye does better, the doctor will observe what’s going on and extend the treatment. There may come a time when the treatments slow down, or you may not need treatment for months at a time. But because of diabetes being there in your body, because the sugars are high, the treatments will be ongoing, sooner rather than later.

And so you need at least regular eye exams, which will be determined by the severity of the disease and what the doctor’s observing in the eye. As the treatment improves and your sugar improves, a question will come up that why am I still getting treatments, if I’m seeing well and my sugars are under control?

The answer is: this is from damage that was done years ago. And even if your sugars are under good control, your sugars are not that of a totally normal, non-diabetic person. Damage is ongoing, and as such you will require at least continuous monitoring, and treatment as needed based on that monitoring.

For more information, talk to your eye doctor, who will guide you on the treatment process.   Often seeing a local Ophthalmologists or Optometrist in conjunction with your family physician or a registered dietician is a great option to dealing with eye conditions and symptoms. Smart Food Now and exercise is also important for overall health.  Presenter: Dr. Amit Gupta, Ophthalmologist, Scarborough, ON

Local Practitioners: Ophthalmologist

When it comes to the frequency and duration of injections for diabetic retinopathy, treatment initially begins on a monthly basis. As your eye responds to treatment, the doctor will assess your progress and may extend the duration between injections. However, due to the ongoing presence of diabetes and high blood sugar levels, the need for ongoing treatment is likely.  Often seeing a local Ophthalmologists or Optometrist in conjunction with your family physician or a registered dietician is a great option to dealing with eye conditions and symptoms. Smart Food Now and exercise is also important for overall health.   

Depending on the severity of the disease and the doctor's observations, regular eye exams will be necessary. While treatment may improve your vision and control your blood sugar, the damage caused by diabetes can persist even with good control. Therefore, ongoing monitoring and treatment as needed will be necessary.

For more information, consult with your eye doctor, who will provide guidance on your individual treatment plan.