Anti-VEGF Injections for Wet Macular Degeneration: Benefits, Risks, and What Patients Should Know

Anti-VEGF Injections for Wet Macular Degeneration: Benefits, Risks, and What Patients Should Know

For people diagnosed with wet (neovascular) age-related macular degeneration, anti-VEGF injections are often described as lifesaving for vision, and in many cases, they truly are.

But patients deserve more than monthly injections into the eye. They deserve clarity, context, and honesty.

Anti-VEGF therapy is one of the most important advances in modern ophthalmology, yet it is not without limitations or trade-offs. Understanding both the benefits and the risks allows patients to make informed decisions and feel empowered—not fearful—about their care.

What Anti-VEGF Injections Do Well

Wet AMD occurs when abnormal blood vessels grow under the retina and leak fluid or blood, damaging central vision. Anti-VEGF medications work by blocking vascular endothelial growth factor (VEGF), the signal that drives this abnormal vessel growth.

Decades of clinical trials have shown that anti-VEGF injections:

• Dramatically reduce the risk of severe vision loss

• Stabilize vision in the majority of patients

• Improve vision in a meaningful subset

• Preserve independence and reading ability for many people

Before anti-VEGF therapy, most patients with wet AMD experienced rapid, irreversible vision loss. Today, many maintain functional vision for years. That is a remarkable success.

Why Injections Are Ongoing (and Not “One and Done”)

One of the hardest aspects of anti-VEGF treatment is its chronic nature.

VEGF suppression is temporary. When the medication wears off, abnormal vessels can reactivate. This is why injections are repeated—often monthly at first, then spaced out based on response.

For patients, this can feel overwhelming:

• Frequent appointments

• Anxiety around injections

• Fatigue from long-term treatment

• Disruption to daily life and caregiving responsibilities

These challenges are real and deserve acknowledgment.

Understanding the Risks—Without Fear

Anti-VEGF injections are generally safe, but no medical treatment is risk-free.

Short-term risks (uncommon):

• Infection inside the eye (endophthalmitis)

• Retinal tear or detachment

• Temporary eye irritation or inflammation

These events are rare, but they are taken seriously.

Long-term considerations (increasingly discussed in research):

• Geographic atrophy progression in some patients

• Possible effects on retinal nourishment with prolonged VEGF suppression

• Cumulative injection burden over many years

It’s important to be clear: anti-VEGF therapy does not cause macular degeneration—but the relationship between long-term VEGF suppression and retinal health is an active area of study. This is why careful monitoring and individualized treatment plans matter.

Why “Personalized Treatment” Is So Important

Not every patient needs injections at the same frequency forever.

Modern care often uses:

• Treat-and-extend approaches

• Individualized dosing intervals

• Careful imaging-guided decisions

The goal is the least treatment needed to maintain vision, not the most.

Patients should feel comfortable asking:

• Why is this injection needed now?

• Can my interval be safely extended?

• What signs suggest we can pause or adjust treatment?

Shared decision-making improves both outcomes and peace of mind.

Anti-VEGF Is Powerful—but Not the Whole Story

One of the most important messages for patients to hear is this:

Anti-VEGF injections treat one pathway of AMD—but AMD is a complex, multifactorial disease.

Oxidative stress, inflammation, mitochondrial dysfunction, vascular health, nutrition, sleep, and lifestyle all influence disease progression. This is why comprehensive AMD care increasingly includes:

• Evidence-based nutritional support

• Smoking cessation

• Cardiovascular and metabolic risk management

• Emerging adjunctive therapies under study

Injections protect vision—but they work best when the retina is supported as a whole.

The Emotional Side of Treatment Matters

Fear of injections, fear of blindness, and treatment fatigue are common—and valid.

Patients do better when they feel:

• Informed rather than rushed

• Heard rather than dismissed

• Supported rather than simply scheduled

Good AMD care is not just technical—it is human.

The Bottom Line

Anti-VEGF injections have transformed wet AMD from a rapidly blinding disease into a manageable chronic condition for many patients.

They are effective. They are necessary. And they deserve respect, not blind acceptance or blind fear.

The best outcomes occur when patients understand:

• What the treatment does

• Why it’s recommended

• What are the risks and limitations

• How can their care be individualized over time?

Vision preservation is a partnership. Informed patients are essential partners.

References (Selected)

1. Rosenfeld PJ, Brown DM, Heier JS, et al.Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1419–1431.PMID: 17021318

2. Brown DM, Kaiser PK, Michels M, et al.Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1432–1444. PMID: 17021319Martin DF, Maguire MG, Ying GS, et al.Ranibizumab and bevacizumab for neovascular age-related macular degeneration (CATT). N Engl J Med. 2011;364(20):1897–1908.PMID: 21526923

3. Grunwald JE, Pistilli M, Ying GS, et al.Incidence and growth of geographic atrophy during 5 years of comparison of AMD treatments trials (CATT). Ophthalmology. 2017;124(1):97–104.PMID: 27528805

4. Jaffe GJ, Martin DF, Toth CA, et al.Macular morphology and visual acuity in the comparison of age-related macular degeneration treatment trials. Retina. 2013;33(1):1–17.PMID: 23203500