Anti-VEGF Treatment Should Not Be Expected to Improve Vision

Clearing up a misunderstanding

Anti-VEGF drugs for treating wet age-related macular degeneration are highly successful at inhibiting neovascularization, but they are limited to that alone. Clinical trials for Lucentis (ranibizumab) and Eylea (aflibercept) are showing better than 90% success at blocking the growth factors responsible for uncontrolled blood vessel growth into the retina, and off-label Avastin (bevacizumab) has been shown to be equally effective. (1) These drugs, however, are not designed to directly improve vision, as many patients believe. Rather, their sole intent is to block future development of leaking blood vessels.
Pravin U. Dugel, MD (Retinal Consultants of Arizona, USC Roski Eye Institute, Keck School of Medicine, and University of Southern California) estimates that, after treatment, only about 25% of patients achieve significant improvement in vision, about 50% achieve driving vision of 20/40 or better, and after 2 years of treatment, about 75% of patients continue to lose vision. (2)
Misunderstanding by some patients arises from the fact that, since fluid from initial leakage is allowed to dissipate after anti-VEGF treatment, some visual improvement has been reported after the first set of injections. The ongoing slow degeneration of the macular cells, however, continues as a natural consequence of the not-yet-curable disease. Permanent improvement in vision is not yet possible, but anti-VEGF drugs are providing years of functional eyesight for patients who would otherwise quickly lose a significant part of their visual field.
To lessen confusion and potential decrease in compliance, this explanation should be made clear to new wet AMD patients and then reinforced often.
1. Antiangiogenic Drugs Are Stopping Neovascularization in Wet Macular Degeneration. Dan Roberts (published online at Living Well With Low Vision, Sept 27, 2012.
2. Anti-PDGF inhibitor development continues despite negative results. Cheryl Guttman Krader (Modern Retina from Ophthalmology Times, June 23, 2017.)