Retina & Vitreous

Anti-VEGF Treatments Do Not Impact on Glaucoma Risk

Abigail Wild
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LONG BEACH, CA – APRIL 01: LONG BEACH, CALIF. USA –Tony Urbiha gets an injection from Dr. Stanley Carson in his Long Beach, Calif. office on June 8, 2011. Urbiha suffers from macular degeneration. Just a few years ago, people of all ages who had the degenerative eye disease were told that they would eventually go blind. Then came a breakthrough, a treatment that seems to halt and sometimes even slightly reverse the condition in one kind of macular degeneration. The treatments include frequent shots in the eyeball to prevents the progression of the disease. Patients come at regular intervals, and special cameras show the condition of the retina and whether a shot is required at that visit. (Photo by Jeff Gritchen/Digital First Media/Orange County Register via Getty Images)
Neither new glaucoma development, glaucoma suspect diagnoses, nor glaucoma progression are associated with intravitreal anti-VEGF injections to treat wet AMD, a study shows.

Treatment with anti-vascular endothelial growth factor (VEGF) injections do not increase the risk, prevalence, or progression of glaucoma in patients with exudative age-related macular degeneration (wet AMD) compared with controls, according to research published in American Journal of Ophthalmology.

Researchers collected data on 707 eyes of 504 patients who received anti-VEGF injections to manage exudative AMD in Olmsted County, Minnesota from January 2004 to December 2013. The investigators compared that data with 1008 eyes of 504 age- and sex-matched patients who either had nonexudative AMD (dry AMD) or no had AMD and were seen for cataract diagnosis. 

The wet AMD cohort received an average of 18 anti-VEGF injections per eye. The cumulative 5-year probability of developing primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), or a glaucoma suspect diagnosis was not significantly different in the injection cohort vs dry AMD cohort (1.8 vs 2%, P =.43) or in the injection cohort vs the no AMD cohort (1.8 vs 2.6%, P =.18), according to the research. The number of eyes that developed glaucoma in each group was not significant either (49/707 vs 98/1008, P =.22; 49/707 vs 86/1008, P =.55, respectively). 

Qualitative reports showed no difference in glaucoma progression in the injection cohort vs the dry AMD and no AMD cohorts (47% vs 38%, P =.10; 47% vs 50%, P =.61, respectively). The researchers also found the cumulative 5-year probability of developing new POAG or NTG was 1.9% for patients who underwent anti-VEGF therapy vs 1% in the dry AMD cohort (P =.69) and 1.6% in the no AMD cohort (P =.88). The 5-year probability of receiving a new glaucoma suspect, POAG, or NTG diagnosis was 1.8% for those who received the injections vs 2% in the dry AMD group (P =0.43) and 2.6% in the no AMD group (P =.18).

Anti-VEGF injections to treat wet AMD do not increase prevalence or progression of glaucoma or diagnosis of glaucoma suspect, according to the researchers. These results offer clarity on the somewhat contradictory research available regarding retinal nerve fiber layer (RNFL) and intraocular pressure (IOP) changes due to anti-VEGF injections. 

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“Exudative AMD eyes receiving injections did require more topical glaucoma medications compared [with wet AMD eyes], and more glaucoma laser treatments compared to the no AMD eyes,” the researchers report.

The limitations of this study include the different practice patterns used by physicians when determining qualitative results, the lack of subgroup analysis on the impact of anti-VEGF injections, the possibility of AMD to impact changes in visual field and  RNFL, and the exclusion of minimally invasive glaucoma surgery from the results. 

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Shah SM, Boopathiraj N, Starr MR, et al. Risk, prevalence, and progression of glaucoma in eyes with age-related macular degeneration treated with intravitreal anti-VEGF injections. Am J Ophthalmol. Published online August 5, 2022. doi:10.1016/j.ajo.2022.07.025

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