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PubMed This is a summary of 23 peer-reviewed journal articles Updated
Ophthalmology · Wet Age-Related Macular Degeneration

Treating Wet AMD: Injections and Strategies

At a Glance

Wet AMD is usually managed with eye injections that block VEGF, a signal that drives leaking abnormal blood vessels, and protect central vision. Treatment often starts monthly, then moves to a personalized schedule; light-activated therapy may help a subtype called PCV.

Modern medicine has transformed wet age-related macular degeneration (wet AMD) from a condition of inevitable vision loss into a manageable one. The cornerstone of this management is anti-VEGF therapy, a treatment that targets the specific protein (VEGF) that causes abnormal blood vessels to grow and leak [1][2].

While the idea of an eye injection can be daunting, these treatments are the most effective way to dry the retina and, in many cases, improve the clarity of your vision [3].

The “Big Four” and Newer Options

There are several medications used to treat wet AMD. While they all work by blocking vascular growth factors, their approved intervals and availability vary by country and patient response.

  • Bevacizumab (Avastin): Originally a cancer drug, this is widely used “off-label” for wet AMD. It is highly effective and often more affordable than other options [1][4].
  • Ranibizumab (Lucentis): One of the first drugs specifically designed for the eye, it has a long-standing track record of safety and effectiveness [1].
  • Aflibercept (Eylea): A common choice that may allow for longer gaps between injections compared to earlier drugs [5]. A newer, high-dose (8mg) version is now available, which has been shown to last 16 weeks or longer for some patients in clinical studies [6][7].
  • Faricimab (Vabysmo): A newer drug that inhibits VEGF-A and Ang-2, which affects vascular stability [8]. Like high-dose aflibercept, it is designed to extend the time between treatments up to 16 weeks for some patients, based on disease activity [9].

Note: 16-week intervals are regimen- and patient-dependent results from clinical studies, not an expectation for all individuals or a guarantee of availability.

Your Treatment Roadmap

Treatment is not a “one-and-done” event; it is a long-term strategy tailored to how your eye responds.

Phase 1: The Initial Phase

Treatment typically begins with an individualized initial phase—often three or four monthly injections, depending on the drug, lesion, and response [10][9]. The goal is to aggressively reduce fluid and stop active bleeding. This phase is critical for stabilizing your vision and preventing early scarring [3].

Phase 2: Maintenance and “Treat-and-Extend”

Once the disease is controlled, your doctor will shift to a maintenance strategy. The most common approach is Treat-and-Extend (T&E) [11].

  • If your eye looks stable on the scan, your doctor will “extend” your next appointment by 1 or 2 weeks.
  • If fluid returns, they will “shorten” the interval to keep the disease under control.
  • The goal is to find the maximum amount of time your eye can go without a leak, proactively giving an injection at each visit to prevent fluid from returning [11][12].

Alternatively, some doctors use a PRN (as-needed) approach, where you are monitored monthly but only receive an injection if new fluid is seen [13]. However, this requires very strict adherence to monthly checkups to avoid “missing” a leak [14]. Note that complete retinal dryness is not always required; small, stable amounts of subretinal fluid may sometimes be accepted depending on vision and other findings.

When Injections Aren’t Enough: PDT

For a specific variant called PCV (Polypoidal Choroidal Vasculopathy), injections alone may not always close the abnormal vessels [15]. In these cases, your doctor might recommend Photodynamic Therapy (PDT).

  • In PDT, a light-sensitive drug is injected into your arm, and a nonthermal light treatment (laser) is then used to activate the drug only in the abnormal vessels of the eye [16].
  • While no longer a standard treatment for “typical” wet AMD, PDT remains a powerful tool for closing the stubborn “polyps” found in PCV [17][18].
  • Crucial Aftercare: Following PDT with verteporfin, you must follow the clinic’s instructions to strictly avoid direct sunlight and very bright indoor light for the specified period (often 48 hours) to prevent severe skin burns.

Safety and What to Expect

Intravitreal injections carry risks that must be balanced against the benefit of saving vision. Serious complications like infection (endophthalmitis) occur in fewer than 1 in 2,000 cases [19]. Common, minor side effects include:

  • A small red spot on the white of the eye (a “bruise” called a subconjunctival hemorrhage) [20].
  • A feeling of “grittiness” or mild irritation for 24 hours [20].
  • Temporary “floaters” or bubbles in your vision [19].

Other Risks:

  • Transient or sustained intraocular-pressure elevation.
  • Severe sterile inflammation.
  • Retinal tears or detachment.
  • There is a low but considered risk of arterial thromboembolic events. You should advise your patients to tell the clinician about a recent stroke, TIA, heart attack, or major vascular disease [21].

Always report new or worsening pain, redness, or a sudden drop in vision to your doctor immediately [22][23].

Common questions in this guide

How do anti-VEGF injections treat wet AMD?
Anti-VEGF medicines block a signal called VEGF that helps abnormal blood vessels grow and leak. By reducing leakage and fluid in the retina, the injections can stabilize or sometimes improve central vision.
How often will I need injections for wet AMD?
Many treatment plans begin with three or four monthly injections, but the starting schedule depends on the medicine, the lesion, and your response. After that, visits may be spaced farther apart or kept more frequent; intervals such as 16 weeks are not appropriate or available for everyone.
What does treat-and-extend mean for wet AMD?
With treat-and-extend care, your doctor checks the retina at each visit and lengthens the next interval by about one or two weeks when the eye is stable. If fluid returns, the interval is shortened, and an injection is given to keep the disease controlled.
When might photodynamic therapy be added to wet AMD treatment?
Photodynamic therapy may be considered when you have polypoidal choroidal vasculopathy, a subtype in which injections alone may not close abnormal vessels. A light-sensitive drug called verteporfin is given through a vein and activated with nonthermal light; afterward, follow instructions to avoid direct sunlight and very bright indoor light, often for 48 hours.
Which medicines can be used for wet AMD injections?
Options include bevacizumab (Avastin), ranibizumab (Lucentis), aflibercept (Eylea), and faricimab (Vabysmo). Bevacizumab is used off-label and may cost less, while the choice and approved dosing intervals depend on availability, country, and how your eye responds.
What warning signs after an eye injection need urgent attention?
Contact your doctor immediately for new or worsening eye pain, increasing redness, or a sudden drop in vision because these can signal a serious complication such as infection. A small red spot, mild grittiness, or temporary floaters can occur, but you should still report symptoms that are severe, worsening, or concerning.

Get notified when new evidence is published on wet macular degeneration.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

References

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This page is for informational purposes only and does not constitute medical advice about wet AMD. Your eye doctor or retina specialist should choose the medication, schedule, and aftercare for your specific eye.

Guide contents wet macular degeneration
Research & Literature
03 Monitoring Your Progress 05 Injections