Can I stop injections for wet AMD?
May I stop injections for wet AMD? This is a common question. Injections are the mainstay of treatment for wet AMD. They reduce the risk of vision loss. However, they are inconvenient, uncomfortable, and costly. At first, Injections are given every month. Over time, they may be given every few months. Unfortunately, long term injections are usually needed to prevent loss of vision. However, there are situations in which injections may be stopped.
In what circumstance may injections be stopped temporarily?
In certain situations, the doctor may recommend a period of observation without injection in wet AMD. For example, a patient may have been unable to return in a timely fashion for injection. Upon delayed examination, the retinal specialist may find the wet AMD to be inactive. Moving forward, injections may be held in this case. Continued close observation is needed to detect recurrent active leakage of abnormal blood vessels in wet AMD.
Rarely, injections may result in inflammation inside the eye. Medication is prescribed to quell the inflammatory reaction to protect against permanent damage. The wet AMD may become inactive in this situation and it may be observed for reactivation.
When might the injections be stopped for the long term?
After months to years of treatment, the vision may decline despite injection therapy. This may happen due to atrophy (loss of tissue) or scarring (fibrosis). If the vision is very poor, injections may be stopped if it is clear that continued treatment will not improve the vision and further treatment is not necessary to prevent worsening of vision. Furthermore, there is limited evidence that suggests injections for wet AMD may worsen dry AMD.
What are the risks of stopping injections?
The main risk of stopping injections for wet AMD is that leaking and bleeding from abnormal blood vessels may cause further loss of vision. This may result in a larger and/or darker central blind spot. However, rarely it may result in total loss of vision in that eye.
The chances of further loss of vision off injections largely depends on whether the macula has active leakage at the time injections are stopped. In a study of 821 eyes observed for one year after stopping injection, Cornish and others found that 8% of all eyes had serious loss of vision. However, 15% of eyes with leakage at the time injections were stopped experienced severe further loss of vision. Therefore, if you have usable vision and wish to avoid further loss of vision, continued injections are preferable. However, if you do not have functional vision and there is no active leakage of the macular degeneration, the risk of further profound loss of vision is low.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
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