Macular Degeneration Treatment: New Long-Acting Options

The right macular degeneration treatment can protect central vision, the sharp vision we need for reading, driving and recognising faces. Age-related macular degeneration (AMD) is one of the most common causes of serious sight loss after 60. The World Health Organization lists it among the leading causes of vision problems worldwide. This guide explains the two forms of the disease, the newer long-acting injections and the warning signs that need a prompt eye check.

What is macular degeneration?

The macula is the central part of the retina. It holds the cells that give us clear, detailed images. With age, this area can slowly wear down. Side vision usually stays, so people do not go completely blind. Everyday tasks, however, can become very hard.

There are two main forms:

• Dry form: the most common type. It progresses slowly, over years, and in advanced stages it can lead to geographic atrophy.
• Wet (neovascular) form: less common, but it causes most of the severe sight loss. New, fragile vessels grow under the retina, leak fluid or blood and quickly damage the macula.

Risk factors include age, smoking, family history and high blood pressure. Smoking is the most important risk factor that we can change.

Symptoms that need an eye doctor

The dry form changes vision gradually. The wet form can change it within days. Book a prompt visit with an eye doctor if you notice:

• straight lines that look wavy, such as tile joints or lines of text.
• a blurred or dark patch in the centre of what you see.
• trouble reading or recognising faces.
• colours that look faded, or a need for much more light.

An Amsler grid helps with checks at home. Look at it every week, one eye at a time. If you see new bent or missing lines, do not wait for the next routine visit. In the wet form, early treatment protects sight far better than late treatment.

How anti-VEGF macular degeneration treatment works

In the wet form, a protein called VEGF plays a central role. It drives the body to grow the abnormal vessels. Anti-VEGF medicines bind this protein, reduce fluid leakage and slow the damage.

The eye doctor gives the medicine as a small injection into the eye (an intravitreal injection). The National Eye Institute states that this treatment can slow or stop vision loss. Many patients even see better. It does not cure the disease, so treatment usually continues for a long time.

Patients usually start with three or four injections, one each month. The doctor then checks the eye with optical coherence tomography (OCT). If the macula stays “dry”, the gaps between injections grow step by step. Doctors call this approach “treat and extend”.

Newer long-acting options: what changes in practice

Older medicines (ranibizumab, aflibercept 2 mg and, off-label, bevacizumab) often needed an injection every 4 to 8 weeks. Newer products aim for longer gaps:

• Faricimab: acts on VEGF and on angiopoietin-2. After the first monthly doses, many patients reach gaps of 12 to 16 weeks.
• Aflibercept 8 mg: a higher dose of a familiar medicine, which also allows fewer injections in suitable patients.

These options suit both new patients and people who have already had older anti-VEGF injections. The eye doctor decides on the gap from the OCT response, not from a fixed calendar. Some patients still need frequent injections. For an older person and their family, fewer visits mean less travel, less stress and an easier schedule to keep.

The injection step by step

The procedure takes a few minutes. The doctor uses numbing drops and an antiseptic solution. A small clip keeps the eyelids open. Most patients feel only pressure. Afterwards, the eye may sting or look red for a day or two. Small floaters in the vision usually fade soon.

Bring a companion and do not drive on the same day. Do not rub the eye, and follow the advice about eye drops.

Risks and when to seek help at once

Serious complications are rare, but not zero. The most serious is an infection inside the eye (endophthalmitis). It happens in about one in several thousand injections. More rarely, inflammation, raised eye pressure or retinal detachment can occur.

Watch the eye closely in the first days after an injection. See an eye doctor the same day if pain grows, redness gets worse, vision drops or light feels very uncomfortable.

The dry form: what can help

Anti-VEGF injections have no role in the dry form. At the intermediate stage, AREDS2-type supplements lower the risk of moving to advanced disease. The eye doctor will judge whether they suit you, as they do not help people without AMD. Some countries have newer medicines for geographic atrophy, but access in Europe is limited.

The basics still matter most:

• stopping smoking.
• a diet with green leafy vegetables and fish.
• regular eye checks.

Read more about food in our guide to nutrition for older adults from ΔΕΛΦΙΝΙ.

Daily life with low vision

Reduced central vision raises the risk of falls and medicine mistakes. Good lighting, strong colour contrast, magnifiers and large print on medicine boxes make a big difference. Our guide to fall prevention at home lists practical changes. The NHS also suggests low-vision services and counselling, because sight loss often brings anxiety or isolation. At ΔΕΛΦΙΝΙ, medical follow-up includes close contact with the eye doctor, so no injection appointment slips through.

Frequently asked questions

How long do the newer anti-VEGF medicines last?

After the first monthly injections, many patients reach gaps of 12 to 16 weeks. The interval varies from person to person, and the doctor sets it based on OCT.

Does the eye injection hurt?

Numbing drops make the procedure tolerable. Most people feel pressure rather than pain, and mild discomfort passes within hours or a day.

Who can have this treatment?

People with the wet form of the disease, whether they are starting now or have already had older anti-VEGF injections. The eye doctor reviews the history and tests before suggesting a medicine.

Will I ever stop the injections?

The wet form is a long-term condition. Some patients take a break when the macula stays stable for a long time. They still need regular checks, because the disease can become active again.

For personal advice about your relative, please contact us and we will get back to you.