Wet age-related macular degeneration (wet AMD) is treated primarily with injections of medication directly into the eye. These drugs block a protein that drives abnormal blood vessel growth beneath the retina, and in large clinical trials they maintained vision in more than 90% of patients. While the idea of eye injections sounds daunting, the procedure is quick, well-established, and has transformed wet AMD from a near-certain path to severe vision loss into a highly manageable condition.
How Wet AMD Damages Vision
In wet AMD, your body grows fragile new blood vessels underneath the macula, the part of the retina responsible for sharp central vision. These vessels leak blood and fluid into surrounding tissue, causing rapid swelling and scarring. Left untreated, this process can destroy central vision within weeks or months.
The protein driving this abnormal vessel growth is called VEGF (vascular endothelial growth factor). VEGF signals your body to build new blood vessels and makes existing vessel walls more permeable, letting plasma proteins seep out and form a scaffold for even more vessel growth. Blocking VEGF is the foundation of nearly all current wet AMD treatment.
Anti-VEGF Injections: The Standard Treatment
Anti-VEGF drugs are injected directly into the vitreous, the gel-like fluid inside your eye. Several are FDA-approved for wet AMD: ranibizumab (Lucentis), aflibercept in both standard and high-dose formulations (Eylea and Eylea HD), brolucizumab (Beovu), and faricimab (Vabysmo). All work by binding to VEGF and preventing it from triggering vessel growth and leakage. In randomized trials, 95% or more of patients maintained their vision within three lines on an eye chart after two years of treatment.
Faricimab stands apart from the others because it blocks two targets instead of one. In addition to VEGF, it also blocks a second protein called Ang-2 that independently contributes to blood vessel instability and leakage. Data from six phase 3 trials found that this dual approach provided greater control over vessel leakage than blocking VEGF alone, which can translate to longer intervals between injections.
Biosimilars, which are near-identical copies of original biologic drugs, have also begun entering the market. The FDA approved a ranibizumab biosimilar in late 2025 and an aflibercept biosimilar shortly before that. These options may help reduce the cost of long-term treatment.
What the Injection Feels Like
The procedure itself takes only a few minutes. Your doctor first applies numbing drops to your eye, then cleans the surface and eyelids with an antiseptic solution to prevent infection. A small device holds your eyelids open so you don’t need to worry about blinking. The injection uses a very fine needle, and most patients report feeling only mild pressure rather than sharp pain. Afterward, a cotton swab is placed over the injection site, and your doctor checks that your vision and eye pressure are normal before you leave.
You may notice some redness on the white of your eye or have a gritty sensation for a day or two. Floaters from the medication are common and typically harmless. Most people return to normal activities the same day.
Treatment Schedules
How often you receive injections depends on the dosing strategy your doctor chooses. There are three main approaches.
- Fixed dosing means injections at regular intervals, typically monthly. This was the first approach studied in clinical trials and produces consistent results, but it requires the most visits.
- As-needed (PRN) starts with three monthly “loading” injections, then switches to monitoring. You receive another injection only when scans show the disease is becoming active again. This reduces the number of injections but requires monthly office visits for monitoring.
- Treat-and-extend is now the most widely used approach. You receive injections at every visit, but your doctor gradually stretches the time between appointments as long as your eye stays stable. If fluid returns, the interval gets shortened. This strategy eliminates the need for separate monitoring visits and aims to treat you just before the disease flares up, rather than reacting after it already has.
With newer drugs like faricimab and high-dose aflibercept, some patients can extend their treatment intervals to every 12 or even 16 weeks. That said, many patients still need injections every 4 to 8 weeks, especially in the first year or two.
Monitoring Between Treatments
A scan called optical coherence tomography (OCT) is central to managing wet AMD. OCT creates detailed cross-sectional images of your retina in under a minute, capturing about 90 images per scan. These images reveal whether fluid is building up beneath or within the retina, which tells your doctor if the treatment interval needs adjusting.
Home monitoring is becoming an increasingly important complement to office visits. Some home OCT devices now use artificial intelligence to check images for signs of fluid and alert your doctor when the disease appears to be reactivating. This is especially valuable for patients on longer treatment intervals, where catching a flare-up early can prevent vision loss between appointments. Simpler tools like the Amsler grid, a printed chart of straight lines, also help you notice distortion in your central vision at home.
Photodynamic Therapy
Photodynamic therapy (PDT) is a much less common treatment that some doctors use alongside anti-VEGF injections. It works by injecting a light-sensitive medication into a vein in your arm. Once the drug reaches the abnormal blood vessels in your eye, your doctor shines a specific type of low-energy laser on a small area of the retina. The laser activates the medication, which then breaks down the leaking blood vessels. PDT is not a standalone treatment for most patients today, but it can be helpful in certain cases where anti-VEGF therapy alone isn’t enough.
Reducing the Injection Burden
One of the biggest challenges of wet AMD treatment is the sheer number of injections and office visits required over years or even decades. Several approaches aim to reduce that burden.
The port delivery system (Susvimo) is a tiny refillable implant surgically placed in the wall of the eye. It continuously releases ranibizumab into the vitreous, and clinical trials showed that refilling the device every six months produced vision results equivalent to monthly injections. Trials have also explored extending the refill interval to nine months. The implant is approved for patients who have already responded to at least two anti-VEGF injections, though it requires a surgical procedure for placement.
Gene therapy represents an even more ambitious approach. A therapy called RGX-314 is currently in phase 3 clinical trials. It uses a viral vector to deliver a gene that instructs cells inside the eye to produce their own anti-VEGF protein continuously. If successful, it could reduce or eliminate the need for repeated injections after a single treatment. Results from these pivotal trials will determine whether this becomes a viable option.
Living With Ongoing Treatment
Wet AMD is a chronic condition, and most people need some form of treatment indefinitely to prevent vision loss. The first year typically involves the most frequent injections, often monthly for the first three months and then at gradually increasing intervals. Over time, your doctor will find the schedule that keeps your retina dry with the fewest possible injections.
Missing or delaying treatments can allow fluid to return and cause permanent damage, so keeping appointments matters. The good news is that with consistent treatment, the vast majority of patients hold onto their central vision for years. Some even gain back letters on the eye chart that they had already lost. The treatment landscape continues to evolve toward longer-lasting options, meaning the practical demands on patients are likely to keep decreasing.