Getting Zen About Eye Injections
Until fairly recently, people diagnosed with wet age-related macular degeneration (wet AMD) had few options. The condition, which causes abnormal blood vessels to leak fluid in the eyes, often lead to irreversible vision loss.
Those days are finally behind us, but they left one teeny downside: The treatment for wet AMD requires an injection directly into your eye (insert 10 scream emojis here!). We know, it sounds like a nightmare, but learning how to conquer those fears means that you’ll get the sight-saving medicine you need. We’re here to walk you through it step by step, starting with some basics about the condition.
How Do You Get Wet AMD in the First Place?
Wet AMD is one of the most advanced forms of macular degeneration, says Frank S. Siringo, M.D., assistant professor of vitreoretinal diseases and surgery at the University of Colorado School of Medicine in Aurora. Again, it’s an age-related disease, but other risk factors include having a family history, having high blood pressure, and smoking, Dr. Siringo says. It affects about 10% of people diagnosed with earlier forms of AMD (often called dry AMD), and without prompt treatment, the condition can lead to vision loss.
So...What Exactly Is Wet AMD?
As eye damage from dry AMD gets worse, levels of a molecule called vascular endothelial growth factor (VEGF) increase. All this extra VEGF causes abnormal blood vessels to grow in the back of your eye behind the retina.
“We hate those abnormal blood vessels because unlike your normal ones, they’re not stable, and they have a propensity to leak fluid or blood,” explains Tim Murray, M.D., a Miami, Florida-based retina specialist and president of the American Society of Retina Specialists. “And that leakage is what damages visual function.” And you guessed it, that fluid is what makes AMD turn from “dry” to wet.”
Why Are Injections Totally Worth Doing?
These medications, knowns as anti-VEGFs “have had immense effects in eliminating the vascular leakage and preserving the vision in the eye,” says Dr. Murray. But what sets anti-VEGFs apart is their ability to potentially improve vision, says Dr. Siringo. “They’ve become the gold standard in the treatment of wet AMD,” he adds. The ones currently available:
- Avastin (bevacizumab)
- Beovu (brolucizumab)
- Eylea (aflibercept)
- Lucentis (ranibizumab)
The downside (besides the needle-in-your-eye part) is that these are not one-and-done treatments. You’ll need to get them regularly so vision loss doesn’t progress.
Ready to Do This Thing?
We’ve got all the info you need so you know exactly what to expect. And here’s the most important part: The whole process—from pre-injection exam to the injection process itself—takes about 60 to 90 minutes, says Dr. Murray—but only a fraction of that time involves any needles!
Step 1: The Pre-Injection Exam
Some doctors do this exam in a separate appointment from the actual injections, but others like Dr. Murray do both in the same day. If you’re nervous, doing everything at once lets you get it over with, so ask your doc if it’s an option.
The exam part involves several steps, says Dr. Murray. Typically, you’ll get a drop of anesthetic in your eye, your eyes will be dilated and photographed, and your eye pressure will be checked. You’ll also have an optical coherence tomography (OCT) test, which gives your doctor a microscopic view of the macula (the center part of the retina), allowing him to track progress.
Step 2: The Lid Speculum
Preparation for the injection usually involves a lid speculum—basically, a little piece of metal or plastic that holds the eyelids open. And that’s the part that many patients end up hating the most, says Dr. Murray—not the injection itself.
Before the lid speculum goes in, you’ll get another drop of anesthetic to numb your eye to pain. But know that the drop won’t fully numb you to touch, so you’ll still feel pressure on the eye when the speculum is in place, says Dr. Murray. Finally, your doctor will apply another anesthetic that’s a viscous gel.
Step 3: Cleaning the Eye
This is another part of the procedure patients often find more bothersome than the injection: disinfecting the eye with betadine.
“[Betadine] is a brown liquid that’s used to prep for surgery,” says Dr. Murray. “It irritates the eye because its function is to kill any bacteria on board, and it’s been shown to be the single most important thing to lower the infection risk.”
Your eyelids or eyelashes may also be cleaned with betadine, especially if a lid speculum isn’t used, says Dr. Siringo.
Step 4: The Injection Itself
Ok, this is it: Your doctor will tilt the chair far back to prevent head movement and may place a soft cotton swab on your eye to stabilize it, says Dr. Siringo. Then he or she inserts a very small, thin needle and injects the anti-VEGF medication into the eye—and it takes “less than five seconds,” says Dr. Murray.
One of the most common concerns people have about this whole procedure is whether the injection is painful, says Dr. Siringo. “Most patients feel the pressure of the medicine entering the eye, and often feel a quick pinch,” Dr. Siringo says. “Very few patients have much pain at all.”
Step 5: After the Injection
The eye is rinsed with saline (bye-bye, betadine), the speculum is removed, and you’re sent to the waiting room—probably with an ice pack. Because the injection can immediately increase eye pressure, your doc will want to make sure it’s at a normal level before sending you home.
You’ll be instructed to avoid pools, hot tubs, or splashing excess tap water into your eye for the two days following your procedure, says Dr. Siringo. You also may see some reddening of the white of the eye for up to a week after—but know this is related to the anesthetic and not a vision-threatening complication.
More Zen-inducing Advice: Find a Great Retina Specialist
“Make sure you have a board-certified ophthalmologist,” advises Dr. Murray. “And the second minimum requirement for me is that they are in one of the three major societies [for retina specialists]: the ASRS, the Retina Society, or the Macular Society.” Check those two boxes and you can feel reassured that you’re getting quality care, he says. You can search for a qualified retina specialist in your area on the ASRS website.
“More than 2 million intravitreal anti-VEGF injections were performed in the U.S. last year, so this is a procedure very comfortable for retina specialists to perform,” reassures Dr. Siringo.
Consider Anxiety-Reducing Drugs
If you’re feeling extremely anxious, you may consider taking an anti-anxiety medication before the injection procedure, says Dr. Murray. Talk to your doctor about this and make sure they know exactly what you’re planning to take. Additionally, he says, some patients in states where medical marijuana is legal may consider using the drug if they have a prescription, or trying CBD products, to help calm their nerves. Again: Always talk to your doctor first.
Bring a Friend or Family Member
You probably don’t want to drive after your eye injection—and if you’re having both eyes done at once, your doctor’s office probably won’t let you, anyway. So it’s helpful to bring a friend or family member with you to your injection appointment. Not only can they drive you home, but they can be there in the waiting room for emotional support and to help you get your mind off what’s to come.
Take Heart: It Will Get Easier
After the first injection, you’ll likely feel a lot better going into future appointments (about every six weeks on average, says Dr. Murray) knowing what to expect.
And here’s another positive: The newest anti-VEGF drug, Beovu, was just approved by the FDA for use every three months (after three initial “loading” doses), and more options may be on the horizon, says Dr. Murray. Yes, that means fewer injections!
“[When I started practicing] in 1991, every person with wet macular degeneration was going to end up blind,” says Dr. Murray. “Now, 85% to 90% are going to keep or improve the vision that they start with. It’s a really exciting time.”