7 Ways to Ease the Stress of Anti-VEGF Injections for Wet AMD

When you were diagnosed with wet age-related macular degeneration (AMD) , you may have felt some relief after learning that there's an effective treatment: anti–vascular endothelial growth factor (VEGF) medication . These injections can not only prevent vision loss, but in some cases improve a person's vision for years, research shows.

Despite the sight-saving benefits of anti-VEGFs, as many as 40 percent of people with wet AMD stop going for the injections within two years.

Some of the most common reasons for stopping the medication include:

• Difficulty traveling to the appointments
• Trouble sticking to the treatment schedule
• Anxiety about receiving an eye injection
• Difficulty paying for the medication
• A lack of communication with the healthcare team
  
  

Sticking to the treatment schedule can be especially difficult. After you're diagnosed, you usually need to have anti-VEGF injections about once a month, says Purnima Patel, MD , a clinical spokesperson for the American Academy of Ophthalmology.

And since you won't be able to drive after getting the injection, you'll need to have a family member or friend accompany you to the appointment and take you home, says Dr. Patel. (Even if you can take public transportation or hire a driver, you may want a loved one there for emotional support.)

For some people, this can take up most of the day, because the treatment center may be hours away from home.

When it comes to the other hurdles of getting treated - fear of the injections themselves, the high cost of the medication, and a lack of understanding about the procedure - Patel stresses that your doctor is on your side.

"A lot of the time, we can find solutions [to your problems]," she says. Here are some that may work for you.

7 Ways to Feel Better About Getting Anti-VEGF Injections

1. Find a Care Team With a Good Bedside Manner

It's hard to feel relaxed while receiving anti-VEGF treatments if you don't feel comfortable with the person who's giving you the shot. Talk to them, and if there's a particular part of the process you're nervous about or uncomfortable with, speak up.

"[By] identifying the most dreaded step, we can work within reason to minimize any discomfort," Patel says.

2.  Ask What to Expect Ahead of Time

You're more likely to feel anxious before and during an anti-VEGF treatment if you aren't well informed about the injection and its side effects, according to a study. This includes when to expect pain or discomfort.

Ophthalmologists may have slightly different ways of administering anti-VEGF treatment, but in general, the procedure goes something like this:

1. First, your doctor will apply medication to numb the surface of the eye using drops, cotton swabs, or a small injection, says Julie M. Rosenthal, MD , a clinical assistant professor of ophthalmology at the University of Michigan W.K. Kellogg Eye Center in Northville.
2. Next, your doctor will apply an antiseptic to prevent infection. "The worst part of the procedure is really the [antiseptic] that's used to sterilize the eye, because it burns a little bit," Patel explains.
3. Once you're ready for the injection , your doctor may fit you with a speculum (a tool that holds your eyes open). Then they'll ask you to look in a certain direction, so you cannot see the needle, says Dr. Rosenthal.
4. You may feel some pressure (or nothing at all) as the needle is injected into the white part of your eye, but you won't feel any pain.
5. After the injection, the numbing and antiseptic medication will be thoroughly rinsed out, and the doctor will do a final check of the eye, says Rosenthal. Typically, you'll be sent home with artificial tears and ointments to help with any pain or irritation. You'll also be given instructions on what to look out for (such as signs of infection or other complications) that may require a follow-up call or visit.

Getting through the first procedure is hard, but "90 percent of patients feel that the injection was much better than they had anticipated in their minds," says Rosenthal. After the first procedure, you'll likely be more comfortable at future appointments.

3. Try to De-Stress Ahead of Time

Even if you're now familiar with the procedure, you could still be nervous the night before an injection. According to a study, nearly 39 percent of people with wet AMD say they felt anxious before every anti-VEGF treatment.

If needles make you nervous, try doing some mind-body relaxation techniques before and during the injection, such as meditation or visualization, Rosenthal suggests. And if your doctor has given you a prescription for antianxiety medication, you can take one before your appointment, says Patel.

4. Look for Transportation Resources

If you need assistance getting to and from appointments , there may be rideshare programs - and even financial support - available to help you with your travel needs. Some insurance plans, such as Medicare Advantage , cover the cost of transportation to healthcare facilities.

Or try looking up transportation benefits in your area by searching "your state" + "transportation benefits". You can also ask your care team for suggestions. They may be familiar with local resources.

5. Get Financial Help

A single dose of anti-VEGF medication may cost you as much as $2,000, depending on your insurance plan.

To help reduce the cost, Patel asks her patients for permission to enroll them in a financial assistance program. "A lot of the time, we can find solutions to significantly bring down the cost," she says.

Ask your ophthalmologist to tell you more about grants, drug manufacturer savings programs, and other resources. Someone in the office may also be able to help you fill out the applications.

6. Don't Be Afraid to Ask for Scheduling Accommodations

Because wet AMD can develop later in life, you may also have other medical conditions to manage, says Patel. "You might need to draw your attention to cancer therapy, or heart disease, or things like that," she says.

Patel says she tries to work with her patients to make adjustments to their schedule, if needed. "We have several patients [that] … if they cancel or can only come in on a certain day, we try to work them in," she says.

7. Try to Stay Positive

When you're getting anti-VEGF injections, it's easy to focus on the negative aspects of the procedure. That's why Patel likes to give her patients visual evidence of how the medication is working.

She shows her patients their past and present OCT (optical coherence tomography) images - scans of the retina commonly done during injection appointments - which can reveal that the medication lessened the amount of fluid in the eye. Seeing the progress can encourage people and remind them that it's all worth it, says Patel.

The bottom line: Being able to communicate with your doctor is a crucial part of the anti-VEGF treatment process, she says. "If you have anxiety, or if you have questions or concerns, you should feel free to bring it up to any of your care staff, including your physician," Patel notes. "We will likely have suggestions that can help guide you."

More in Wet AMD

The Consumer's Guide to Anti-VEGF Treatments for Wet AMD

5 Ways to Get to and From Your Wet AMD Eye Appointments

5 Wet Macular Degeneration Myths

Tips to Make Working Easier With Wet Age-Related Macular Degeneration

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