Anti -VEGF intravitreal injection treatment

Before you are due to attend for your eye injection if you have any of the following conditions or are any of the following medications you need to ring and let us know.

• if you have any cold sores, shingles or chicken pox virus
• any infection
• if you are currently on, or about to commence antibiotics
• had a stroke, TIA, or heart attack within the last 3 months.
• Important Note: If you have suffered a stroke, TIA or heart attack within the last 3 months, then it would be necessary to postpone treatment. Injections will start again after a discussion with your care team
• if you have or are experiencing any diarrhoea and vomiting prior to your injection, please contact the eye centre for advice.
• please ensure you have an unopened supply of eye drops following your injection
• please do not drive to/from your injection appointment and for the rest of the day
• do not wear eye makeup to your injection appointment and for a few days afterwards to help minimise the risk of infection
• to help reduce the risk of infection it is recommended that regular eyelid hygiene is carried out especially in patients who have a condition called Blepharitis
• please ensure that your glasses are clean prior to your injection to help reduce the risk of infection
• do not use contact lenses on the day of and for a few days after your injection

• you may receive lubricating eye drops after the injection to take home. Please use as directed and start a fresh bottle after each injection
• try and avoid soap and water getting into your eye for 2 days
• no gardening for two to three days afterwards
• no swimming for one week
• occasionally, we may ask you to wait to have your pressure checked before you go home

Common side effects following an intravitreal injection 

• your eye may feel gritty and ache slightly for a day or two after the injection
• your vision may be slightly blurred for a day or two after the injection
• ‘Blobs’ or ‘small specks’ in your vision (floaters) might be seen for a few days after the injection. You may also experience a brief episode of flashing lights or swirls of light immediately after the injection
• red eye (there is usually a bleed or bruise on the white part of the at the site of injection, which can take up to two weeks to clear
• do not rub your eye after your injection as there is a risk of causing a scratch to the surface of the eye whilst the numbing drops are still working

All of these symptoms should improve on a daily basis.

What you can do to make your eye more comfortable? 

• if necessary, you can take some painkillers. Something you normally take for a headache should be fine
• lie down and rest
• instil the lubricating eye drops given to you as instructed by the nurse/doctor

It is important to note that most of the discomfort relating to injections is due to the use of Povidone Iodine antiseptic. This is a vital part of the injection process and reduces the risk of infection. You may be sensitive to the iodine and so your injector practitioner will make sure to wash it out. Please note that allergies to Iodine are extremely rare. 

Serious side effects

•  Serious eye infection (one in 3,000 cases) which can lead to blindness.

If you experience any of the following, contact the eye centre immediately on 01896 826765 Monday to Friday 8.30am to 5pm or NHS 24 on 111 if out with these hours.

• increasing pain/ache in the eye despite taking a simple pain killer
• decreased vision
• prolonged blurred vision
• sensitivity to light
• worsening redness
• pus or discharge from your eye
  If you delay seeking advice, it may be damaging to your vision.

Less common side effects

• cataract
• retinal detachment raised intraocular pressure
• blood clots and bleeding in your eye
• inflammation inside the eye

Most patients receiving intravitreal injections require a course of treatment, the doctor at the eye centre will discuss this with you. For many patients, further intravitreal injections are required to maintain the benefit of treatment.

If you are concerned or experience any sudden deterioration in vision or pain, please contact the Eye Centre on 01896 826765 Monday to Friday 8.30am to 5pm or NHS 24 on 111 if out with these hours.

Family and Friends

They can support you both physically and mentally. They can chat to you about your problems and accompany you or bring you to the clinic. This can make life easier.

Your Healthcare Team

The Ophthalmologist and nurses within the team are all here to help you.

Your GP

Your GP can provide support to you if you feel you are feeling overwhelmed by your diagnosis.

Eye Clinic liaison officer (ECLO)

This is a service that is provided by the Royal National Institute of Blind People (RNIB) and they are located within the Eye centre. They offer practical and emotional support to people living with a sight condition, and their families and carers. Phone the ECLO officer, Allison Paton Day on 07771 940 387/01896 827825 or email Alison.Patonday@rnib.org.uk    RNIB Helpline-0303 1239999

macularsociety.org.uk

You can view patient stories and video accounts to learn more about living with wet-AMD.

Other Patients

You can talk to other patients who have wet-AMD about your experience and theirs.

Treatment Buddies

Treatment Buddies support people who are anxious about their injections and offer information and

reassurance. To talk about injections and treatment buddies call the Advice and Information Service at the Macula Society on 0300 303 0111 or email help@macularsociety.org

Counselling

Sometimes it helps to speak to a professional counsellor, who is trained to listen and will help you talk through your feelings and find ways of dealing with them. Phone 0300 303 0111 or email help@macularsociety.org

Telephone Befriending Service

The Macular Society aims to find you a befriender who shares your interests or experiences, and who understands exactly what it is like to live with a macula condition. For more information, please contact the Macula Society. 

Scottish Borders Macular Society Group

First Monday of every month 1.30pm – 3pm

Church of Scotland (Trinity)
60 High Street Galashiels
TD1 1SE

The meeting is open to anyone affected by central vision loss. Free transport is available from surrounding villages. Family, friends and carers are welcome.

Contact IONA  07517 543 998

What is an Amsler Grid?

It is grid of horizontal and vertical lines used to monitor a persons central vision.

How do I use the Amsler Grid?

• hold the grid at your normal reading distance, wearing your reading glasses

• cover one eye and focus at the dot in the centre of the grid

• repeat the test with the other eye

If the lines appear to be more wavy, distorted or broken in any way you should contact the macula department within 1 week, as it may mean there has been progression in the macular degeneration.

How often should I do this test?

Weekly, use the chart below. Some people find it helpful to have it attached to somewhere/something that they see/use often such as the fridge.

I Have WAMD, what is the difference between wet and dry age-related Macular Degeneration?

Most people over the age of 70 (about 75%) have dry macular degeneration. This is part of our natural ageing process. It is caused by a build-up of waste material in the back of the eye.

Wet macular degeneration occurs when abnormal blood vessels grow underneath the retina at the back of the eye. We don’t know why some people develop this and others don’t. Lifestyle and genetics can be responsible, a small number of people could have DRY AMD and this may progress into WET AMD.

Does my eye condition affect my ability to drive?

If you have a car or motorcycle licence:

You can be fined up to £1,000 if you do not tell DVLA about a medical condition that affects your driving. You may be prosecuted if you’re involved in an accident as a result.

You must tell DVLA if you:

• have a certain type of eye condition that affects both eyes (or one eye when you only have vision in one eye)
• have been told you may not meet the visual standards for driving by a GP, optician or eye specialist

The visual standards for driving

You should meet the standards if you:

• can read a number plate from 20 metres away
• have no double vision
• have a normal field of vision in at least one eye (your optician can test this).

If you’re not sure if you meet the visual standards for driving, you should get advice from your GP, optician or an eye specialist.

You must not drive on the day of your appointment. Please arrange other transport method.

What can I do to help my condition?

• It is important for your general health to take regular exercise, stop smoking, maintain a healthy weight and to have a diet rich in fresh fruit, nuts and dark leafy green vegetables (such as spinach).
• Keep your blood pressure and cholesterol under control.
• Wear sunglasses outdoors to block UV and blue light that may cause eye damage.

Is there a limit to the number of injections I can have?

We will continue to offer injections as long as they are effective in helping to control the progression/ symptoms of your condition and you as a patient wish to and are able to continue on the programme of injections.

Should I put my normal eye drops in before attending for injection?

Put your eye drops in as usual before attending clinic (do not use any gel medication you have been prescribed).

Will I see the needle?

Prior to administering the injection, the patient is directed to look away so it is very unlikely you will see the needle.

Will it hurt?

You may experience some discomfort but local anaesthetic is used to minimise this.

I have been prescribed injections to both eyes, can I have the injections on the same day?

If you choose to have both eyes treated during the same appointment, it may be advisable to have a friend or family member accompany you home.

Can I plan my holiday?

We advise you not to fly for 24 hours after your injection. If you are planning holidays whilst having treatment it is advisable that you remain within the country for 3 to 4 days after the procedure. It is important that you try and keep to the treatment schedule if possible.

What are the risks with these injections?

As with any medical procedure, there is a small risk of complications following anti-VEGF treatment.  Most complications that might occur are from the injection itself, rather than the drug. For most  patients, the benefit of the treatment outweighs the small risk of injection injury.

For a list of rare and common side effects of the drugs, please see the individual drug patient  information leaflets.

The following are the major potential risks and side effects of anti-VEGF injections, but this is not a complete list of all risks. These risks are all rare. Significant loss of vision due to this treatment is very uncommon.

• Serious eye infection (one in 2,000 cases)
• Detached retina
• Increase in eye pressure
• Blood clots and bleeding in the eye
• Inflammation inside the eye
• Cataract