Studies showed anti-VEGF injections in wet AMD didn’t increase the risk of developing glaucoma, but people with both wet AMD and glaucoma had an elevated likelihood of visual field progression.
Do you or someone you know suffer from wet age-related macular degeneration or glaucoma? These eye conditions can greatly affect your vision and overall quality of life.
While treatments like anti-VEGF injections have demonstrated success in managing wet AMD, there have been concerns regarding their potential impact on intraocular pressure and the associated risk of developing glaucoma.
In this article, we will delve into two valuable research studies that were recently published, shedding light on the connection between anti-VEGF treatment in wet AMD and glaucoma. Join us as we explore the findings and implications of these studies.
Wet age-related macular degeneration and glaucoma
Let's begin with a quick recap of the two conditions and the rationales of the concerns. Wet age-related macular degeneration (wet AMD) is a progressive eye disease that is characterized by the abnormal growth of blood vessels in the macula, which is the central part of the retina. It is recognized as one of the primary causes of permanent visual impairment or legal blindness in developed countries, including the United States.
In the treatment of wet AMD, a commonly employed approach involves intravitreal injections. These eye injections deliver medications known as anti-vascular endothelial growth factors (anti-VEGF) directly into the eye. Numerous studies have demonstrated the success of this therapy in stabilizing and, in some cases, even improving vision in wet AMD.
Glaucoma is recognized as the second leading cause of blindness worldwide. It is a group of eye conditions that can result in damage to the optic nerve, often caused by increased intraocular pressure (IOP) and abnormalities in vascular factors. The condition is characterized by the gradual loss of peripheral vision, which can eventually progress to tunnel vision.
Extensive research has established a clear correlation between IOP and the progression of glaucoma. Elevated pressure within the eye can cause damage to the optic nerve, resulting in vision loss. Consequently, reducing IOP is a crucial aspect of glaucoma treatment.
Interestingly, researchers found an increased likelihood of glaucoma among individuals with wet AMD. They proposed that this association might be attributed to the shared underlying vascular pathophysiological pathways between these two conditions. However, further research is necessary to fully comprehend the relationship between wet AMD and glaucoma.
Anti-VEGF Injections: Impact on IOP and visual field
Wet AMD is commonly managed using anti-VEGF injections, which may have potential side effects, including an increase in IOP.
A meta-analysis study published in 2020 found that anti-VEGF injections could result in a temporary spike in IOP, typically subsiding in an hour. However, it is important to note that the IOP subsequently drops below the patient's baseline within approximately one day and returns to normal after about a week.
Furthermore, a study has indicated that individuals with both glaucoma and wet AMD, requiring anti-VEGF treatment, may experience a faster decline in their visual field (VF). However, it is not clear if this was driven by macular degeneration or anti-VEGF treatment since macular diseases may worsen the central visual field.
Does wet AMD treatment increase the likelihood of glaucoma?
Researchers have conducted studies to explore the association between wet AMD and glaucoma. In a study published last year, medical records of patients who underwent anti-VEGF injections for wet AMD were identified and reviewed by researchers. The study involved 707 eyes of 504 patients who received anti-VEGF injections, along with 1,008 eyes in the dry AMD (AMD with no injection) and no-AMD control groups.
The findings of the study indicated that the prevalence of glaucoma or glaucoma suspect was not higher in the eyes treated with injections compared to those with dry AMD or no AMD at all. Moreover, there were no significant differences observed in the probability of developing glaucoma within 5 years after the injection among the various groups. However, it is worth noting that the eyes receiving injections required a greater number of medications to manage glaucoma.
Another ten-year study conducted in Finland, also published this year, involved a retrospective real-world data analysis of medical records of 6,314 glaucoma patients and 2,166 patients with wet AMD. The study found that the prevalence of both diseases occurring together was similar to the age-adjusted prevalence of each disease in the general population.
And, both studies also demonstrated that eyes affected by existing glaucoma and wet AMD, treated with anti-VEGF treatment, may experience an accelerated rate of visual field progression.
In conclusion, although there have been concerns about the potential impact of anti-VEGF injections on intraocular pressure and the associated risk of developing glaucoma, recent studies indicated that the prevalence of glaucoma or the likelihood of developing glaucoma was not higher in eyes treated with anti-VEGF for wet AMD.
However, it's important to note that in patients with both wet AMD and glaucoma, studies demonstrated that the progression of visual field loss may occur at an accelerated rate.
Therefore, if you have glaucoma and wet AMD, it's crucial to communicate and collaborate with both your retina and glaucoma specialists to ensure the optimal management of your conditions!
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