Eylea (aflibercept) Therapy

Eylea vial image


What is Eylea® therapy?

Eylea therapy is a treatment for diabetic retinopathy, retinal vein occlusion and wet-type macular degeneration.  It involves repeated painless injections of medication into the eye to prevent blindness by stopping abnormally leaky blood vessels that occur in the eye conditions listed above.  Other similar medications that are also used in these conditions include Avastin, Lucentis, Vabysmo, and Beovu.

How effective is Eylea therapy?

Eylea was proven in FDA-approved studies to be effective. In wet-type macular degeneration, monthly or bimonthly injections of Eylea over a one-year period offered a 95% chance of losing less than three lines on a standard eye chart. Eylea was also shown to be effective in the treatment of diabetic retinopathy and retinal vein occlusion to improve vision and prevent severe complications. The results with Eylea are similar to treatment with Lucentis, Avastin, and Beovu. Eylea therapy often starts with injections every 4-6 weeks. Afterwards, the injections may be given less frequently.  In some cases the injections may be stopped, but continued monitoring is necessary. There are several medication options apart from Eylea. The best choice of medication may depend on the underlying diagnosis.

What are the risks of Eylea therapy?

Severe complications are very rare, but risks of Eylea injection include bleeding, inflammation, infection, retinal detachment, cataract, glaucoma, and loss of vision/loss of the eye. The risk of retinal detachment is about 1 in 5,000 injections, but the results of surgical repair are poor.  There may be an increased risk of difficultly with future cataract surgery estimated to be about 1% of cases. In these cases the fibers (zonules) that hold the cataract in place may become weaken from Eylea injection. When this occurs, special techniques are required to remove the cataract and place a lens implant. Rarely, two procedures are required to accomplish the task.  Studies are ongoing to determine if there may be an increased risk of stroke with Eylea therapy. The possible risk of stroke may be related to the older age of patients with AMD. Further investigation will provide more information. Pregnancy should be avoided while on Eylea therapy.

intra-ocular injection
Intra-vitreal injection

What do I expect after an Eylea injection?

Be careful not to rub the eye after the injection because the eye may remain anesthetized for several hours. You may be given eye drops and instructions on how to use them. Physical activity is not limited after the injection. Tylenol or Ibuprofen may be used if there is discomfort after the injection, but severe pain should be reported to your doctor without delay. It is normal to experience a red area on the white of the eye, which disappears in one to two weeks. If you have any questions or concerns, please call the doctor’s office.

By Scott E. Pautler, MD

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.

Copyright  © 2001-2022 Designs Unlimited of Florida.  All Rights Reserved.

Avastin Therapy for Retinal Disease

What is Avastin therapy?

Avastin therapy is a treatment for retinal conditions involving abnormal blood vessel leakage including wet-type age-related macular degeneration, myopic macular degeneration,  retinal vein occlusion, diabetic retinopathy, and cystoid macular edema. The treatment involves the painless injection of medication into the eye to stop the leakage and improve vision. The benefits of treatment last one or more months. Repeat injections are common in order to keep the leakage from returning. When the problem has stabilized, the injections may be given less often or discontinued in some conditions. Avastin has not been reviewed by the FDA for use in the eye; therefore, it is used off-label. Safety and effectiveness has been established through extensive experience with the use of Avastin in the eye for a multitude of problems since 2005. There are other similar drugs that have been FDA-approved for use in the eye including Lucentis, Eylea, Vabysmo, and Beovu. These drugs are much more expensive than Avastin. Avastin costs about $50 compared to $2,000 with the FDA-approved drugs. There may be reasons to use one medication over another depending on the diagnosis.

How effective is Avastin therapy?

Avastin has been found to be effective in the treatment of a variety of retinal disorders of blood vessel leakage. It was shown to be as effective as Lucentis in the treatment of wet-type macular degeneration in most patients. Avastin is also effective in the treatment of macular edema, retinal vein occlusion, diabetic retinopathy and other conditions of the eye.

What are the risks of Avastin therapy?

Severe complications are very rare, but risks of Avastin injection include bleeding, infection, inflammation, glaucoma, retinal detachment, cataract, and loss of vision/loss of the eye. The risk of retinal detachment is about 1 in 5,000 injections, but the results of surgical repair are poor. There may be an increased risk of difficultly with future cataract surgery estimated to be about 1%. In these cases the zonules that hold the cataract in place may become weaken from Avastin injection. When this occurs, special techniques are required to remove the cataract and place a lens implant. Rarely, two procedures are required to accomplish the task. Studies are ongoing to determine if there may be an increased risk of stroke with Avastin therapy. Further research is needed. However, pregnancy should be avoided while on Avastin therapy.

There appears to be a greater risk of high eye pressure (glaucoma) in eyes treated with Avastin compared with Lucentis and Eylea. This may be especially important in patients at increased risk of glaucoma due to past high eye pressures or positive family history of glaucoma.

Because Avastin must be measured and placed in a syringe by a compounding pharmacy after manufacture, there may be increased risk of complications with Avastin compared with other similar drugs such as Lucentis, Eylea, Beovu, and Vabysmo. There may be an increased risk of infection due to the introduction of bacteria during repackaging.  Some patients experience persistent round floaters due to silicone droplets used to lubricate the syringe from the pharmacy.  Over the years, there have been concerns over needle quality (sharpness), which can make injection more uncomfortable.

intra-ocular injection
Intra-vitreal injection

What do I expect after an Avastin injection?

If a patch is placed on the eye, keep it on as directed by the doctor, usually 3-4 hours. You may be given eye drops and instructions on how to use them. Physical activity is not limited after the injection. Tylenol or Ibuprofen may be used if there is discomfort after the injection, but severe pain should be reported to your doctor without delay. It is normal to experience a red area on the white of the eye, which disappears in one to two weeks. If you have any questions or concerns, please call the office.

By Scott E Pautler, MD

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.

Copyright  © 2001-2022 Designs Unlimited of Florida.  All Rights Reserved.