Retina and AMD · Co-management
Anti-VEGF Injections for wet AMD, and where your practice fits.
Intravitreal anti-VEGF drugs are given by retina specialists, but the patient usually first shows up in a primary eye care chair. This guide covers the agents, their dosing intervals and the detection and co-management work that keeps patients in your practice between injections.
Quick answer
Find it fast, refer fast, stay involved.
Wet AMD is late-stage disease in which abnormal vessels damage the macula, and it usually causes faster vision loss than dry AMD. Anti-VEGF injections may stop further vision loss. Your role is early detection with OCT and symptom education, a prompt referral, and ongoing primary care, nutrition and low vision support once treatment starts.
Key takeaways
- Anti-VEGF agents are injected into the eye by a qualified physician, usually a retina specialist.
- Newer agents and higher doses let some patients stretch intervals to 16 weeks or more.
- FDA approved the first interchangeable biosimilars to Eylea in May 2024.
- OCT findings of fluid are what drive treatment decisions, so baseline scans matter.
- Patients stay yours for refraction, dry eye, nutrition and low vision care.
The agents patients will ask about.
Dosing as written in each FDA label. Specialists individualize intervals from OCT and visual acuity.
Aflibercept 2 mg
Eylea and its biosimilars, including Yesafili, Opuviz, Ahzantive, Enzeevu and Pavblu, all approved by FDA in 2024.
Aflibercept 8 mg
Eylea HD: three monthly doses, then every 8 to 16 weeks, with every 20 weeks considered after a year of response in wet AMD.
Faricimab
Vabysmo, 6 mg, blocks both VEGF-A and angiopoietin-2. Four monthly doses, then intervals set from OCT and acuity.
Ranibizumab
Lucentis and its biosimilars, including Byooviz (2021) and Cimerli (2022).
Brolucizumab
Beovu (brolucizumab-dbll), first approved in 2019 for wet AMD and later for diabetic macular edema.
Biosimilars
FDA approved Byooviz, the first biosimilar for macular degeneration, in 2021. More ranibizumab and aflibercept biosimilars have followed.
Who does what in co-managed wet AMD.
A simple division of labor keeps the patient moving and the record complete.
| Step | Primary eye care | Retina specialist |
|---|---|---|
| Detection | Symptom history, Amsler or home monitoring, dilated exam and OCT | Receives the referral |
| Referral | Prompt referral with images and OCT attached | Confirms diagnosis, often with angiography |
| Treatment | Explains what injections involve and why visits matter | Injects and sets the interval |
| Between injections | Refraction, dry eye care, AREDS2 formula for the fellow eye | OCT-guided interval changes |
| Long term | Low vision evaluation and rehabilitation referrals | Ongoing injections as needed |
Injections are only part of wet AMD care. Patients receiving them still need glasses, ocular surface care and nutrition guidance. Make sure every referral letter asks the specialist to send the patient back for primary care.
Frequently asked questions
Can optometrists give anti-VEGF injections?
In most states intravitreal injection is outside optometric scope. Each label states the drug must be administered by a qualified physician.
How often are injections given?
It depends on the drug and the response. Labels start with monthly loading doses, then specialists extend intervals based on OCT and visual acuity.
What is a biosimilar?
A biologic that FDA has found highly similar to an approved reference product. FDA has approved several biosimilars to Eylea and Lucentis, and some are designated interchangeable.
What should a referral include?
Visual acuity, symptom onset, OCT and fundus images, and which eye is affected. Refer suspected new wet AMD promptly; many practices aim for a same-week retina appointment.
Should patients on injections take AREDS2?
The NEI notes that the AREDS formula may slow AMD in the other eye when late AMD is present in one eye. Coordinate with the retina specialist.
What are the main injection risks?
Labels warn of endophthalmitis and retinal detachment after intravitreal injection. Patients should report pain, redness, light sensitivity or vision changes right away.
References
- National Eye Institute. Age-related macular degeneration: treatment. NEI
- Genentech. VABYSMO (faricimab-svoa) Prescribing Information. Genentech PDF
- Regeneron. EYLEA HD (aflibercept) Prescribing Information, via DailyMed. DailyMed
- U.S. Food and Drug Administration. Biosimilar product information. FDA
- Every source used across these guides is listed on the Vision Rescue sources page.
About this guide
Written for licensed eye care practices by the Vision Rescue team. Questions: providers@visionrescue.com or 1-855-692-8024.
Important notes and disclosures
Information only, not clinical or legal advice. Product names are trademarks of their owners and appear for identification; Vision Rescue does not endorse or review them. Scope of practice, coverage and coding rules vary by state and payer, so confirm locally. Clinical decisions rest with the treating eye doctor.
Detect early, refer clean, keep the patient.
Use imaging to catch conversion, a written referral pathway to move fast, and RescueLink to keep nutrition and dry eye care going between injections.