An End to Eye Injections?

Published in Hopkins Medicine - Spring/Summer 2022

As many as a third of those with “wet” age-related macular degeneration may someday be able to safely stop eye injection therapy without further vision loss, according to the results of a preliminary study of 106 people with the blinding retinal disease.

The Johns Hopkins team that conducted the study fell short of setting a timeline for ending treatment or predicting precisely which patients can stop injections, but they say the results add to growing evidence that many people with the disease may not need the lifelong monthly medication currently recommended.

The findings also point to specific proteins produced at different levels in the eyes of those who stopped therapy, which may lead to the development of a test to accurately identify who may be weaned off medication, the investigators say.

“Such a test could let us tell patients early on how well they would do and when they might be able to stop,” says ophthalmologist and study leader Akrit Sodhi of the Wilmer Eye Institute at Johns Hopkins, whose team reported their results in the Journal of Clinical Investigation.

Age-related macular degeneration (AMD) is the most common cause of vision loss among people age 50 and older. The majority of those who lose vision from the condition have the wet form, characterized by the abnormal growth of blood vessels that leak damaging fluids into the light-sensitive tissues of the eye.

Treatment of wet AMD requires monthly or bimonthly injections of drugs called anti-VEGF — or anti-vascular endothelial growth factor — into the eye. Anti-VEGF agents can slow or stop the growth of the leaky blood vessels and, in most cases, effectively stave off further vision loss. However, the need to return to a physician’s office or clinic each month for injections is a common barrier to care among patients, leading to missed treatments and potentially worsening vision.

Sodhi notes that randomized clinical trials in a large group of patients with wet macular degeneration must happen before broader recommendations on pausing anti-VEGF therapies can be developed.