How Eye Injections Work for Geographic Atrophy

Geographic atrophy is the most advanced form of dry age-related macular degeneration (AMD). During the late stages of this disease, the retina in your eye grows thin, leading to central vision loss and blind spots.

Previously, there weren’t any treatments for geographic atrophy. Now, there are monthly eye injections that can slow down the progression of geographic atrophy.

Ophthalmologist Kevin Keppel, MD, explains what to expect from these treatments and how they work over time.

What are injections for geographic atrophy?

There are currently two monthly eye injections that can slow the progression of geographic atrophy:

• Izervay®: Avacincaptad pegol works by blocking C5, a specific complement protein that can trigger inflammation and damage retinal cells. In clinical trials, monthly 2-milligram injections slowed geographic atrophy growth within six months, and continued to slow it over two years.
• Syfovre®: Pegcetacoplan injections work by blocking C3 and C3b, proteins that are involved in the overactive immune response behind the disease. Clinical trials showed the growth of geographic atrophy slowed by 19% to 22% when given every four weeks, and 16% to 18% when given every eight weeks.

“Geographic atrophy injections are relatively new,” explains Dr. Keppel. “Unfortunately, you won’t notice any improved vision with the injections, but they’re done as a form of long-term protection for the vision you still have.”

Managing anxiety before eye injections

Eye injections can be a major source of anxiety. No one likes the idea of getting poked in the eye, especially with a needle. But healthcare providers do what they can to make it as comfortable and pain-free as possible.

“A lot of people understandably have hesitancy with eye injections,” shares Dr. Keppel. “The vast majority of people who get eye injections end up saying the experience was much easier than they imagined it would be.”

If anxiety is holding you back from getting an eye injection, consider the following advice:

• Talk to your doctor. Bring up your fears and concerns about the procedure and ask questions about what will be done. The answers may help ease your worries.
• Take a family member or friend. “If possible, bring someone with you for the first injection. They can provide a hand to hold or encouraging advice,” suggests Dr. Keppel. “But if you come in alone, your care team will still be there to support you.”
• Listen to music. A small distraction during an eye injection can help put your mind at ease. Bring your headphones, and try to relax as best you can.
• Make yourself comfortable. Try calming techniques, like deep breathing exercises.
• Think of the benefits. Remember, this procedure is for your long-term eye health. Plus, it only takes about 10 or 15 minutes — with most of the time spent numbing the eye so you won’t feel any pain.
• Ask for anxiety medication. If you feel like you need more assistance, you can get a prescription for short-term anxiety medication to help you get through the procedure more comfortably.

What to expect during treatment

Here’s what happens during an eye injection:

• Numbing: Your provider will use a few rounds of numbing eye drops. “We’ll then numb a little more deeply, either with a stronger numbing medication or a numbing shot, to totally numb the area where we plan to do the injection,” explains Dr. Keppel.
• Cleaning: Your provider will then clean your eye with an antiseptic to kill any bacteria living on the surface of your eye and minimize the risk of infection.
• Supporting: Providers may use what’s called an eyelid speculum to keep your eyelids open during an eye injection. “This won’t hurt, but you might feel a little bit of pressure,” says Dr. Keppel.
• Injecting: While you look up, a provider will insert the needle at the base of your eye and inject the medication. “The injection itself is pretty quick,” he reassures. “You might feel a little pressure at the bottom of your eye, but then it’s over.”
• Rinsing: Afterward, your provider will give your eye one last rinse. Then, you’re all done!

“In total, the entire procedure takes about 15 minutes or less,” says Dr. Keppel. “You get them once a month on a recurring basis.”

Risks of eye injections

It’s common to experience some short-term irritation or watery eyes. In some cases, you may notice visual floaters immediately after an injection. Usually, these side effects go away within 24 hours.

More serious side effects, though rare, can include:

• Infection
• Inflammation
• Bleeding
• Retinal detachment
• Corneal abrasion

Treatments for geographic atrophy also increase your risk of developing wet macular degeneration, another form of advanced AMD that has the possibility of causing more rapid visual changes. “Fortunately, wet AMD can be treated, and your vision can return to baseline if the disease is caught early,” says Dr. Keppel.

Your healthcare provider will monitor for this and other side effects closely while you’re receiving Izervay or Syfovre.

“Most of the side effects or risks are related to the injection process itself,” he clarifies. “Anytime you consider one of these procedures, have an in-depth conversation with an eye specialist about the potential risks.”

Follow-up care

In the first 24 hours after an eye injection, it’s important to avoid:

• Rubbing or scratching your eyes
• Wearing eye makeup
• Swimming or getting tap water in your eye

Over time, as you continue to get monthly eye injections, an eye specialist will monitor the growth of geographic atrophy and how the medications are working.

Should you get an eye injection?

Though the idea of eye injections may be uncomfortable at first, it’s a promising treatment that can save your quality of life as you continue to age. The upside of these injections is that they represent major progress in this field.

“We didn’t have any treatments at all for geographic atrophy just a few years ago. Now, we have two treatment options, and I suspect we’ll have more someday soon,” encourages Dr. Keppel.

“These medications work, and they slow geographic atrophy down by about 20%, so they can help to preserve vision and quality of life.”