Diagnosis and treatment


Age-related macular degeneration (AMD) is diagnosed by eye care specialists called optometrists.  This will usually be following a referral from your optician or your GP. An optometrist assessment is usually recommended after changes in vision are noticed during a regular eye exam with your optician or your GP as part of a regular check up.

To check for AMD, the optometrist will use a magnifying glass with a light to look at the back of your eyes and check your vision. They may put drops in your eyes to dilate your pupils making to it easier for them to spot any problems. These drops can temporarily blur vision for 4-6 hours, so do not drive immediately after an exam until sight returns to normal.

If AMD is suspected, you may be referred to an eye doctor (ophthalmologist) or specialist AMD service. If you need to start treatment quickly you should be referred within a day. Additional imaging tests, like a retinal scan, may be ordered to evaluate AMD severity.

Regular comprehensive eye exams, even without vision changes, are advised to detect early AMD before major vision loss occurs. Early detection and timely treatment are key to preserving sight threatened by AMD progression.


There are two types of age related macular degeneration AMD, dry AMD and wet AMD. 

Unfortunately, there are currently no dry macular degeneration treatment options available. However, vision aids and practical support, such as magnifying lenses, brighter lighting and special software on your devices can minimise its impact on your day-to-day life. You can use digital technology to monitor your vision at home, such as Alleye which provides tests to detect any early decrease in your vision. Speak to your healthcare team if you’d like to know more.

Wet AMD is treated with anti-VEGF (vascular endothelial growth factor) injections into the eye. These medicines, also known as anti-angiogenic medicines, stop abnormal blood vessels from growing, leaking and bleeding under the retina. Most people need repeat injections several times per year to control wet AMD.

Photodynamic therapy (PDT) is sometimes added to anti-VEGF injections. PDT is a laser that shines light into the back of the eye to destroy abnormal vessels. However, PDT alone is rarely effective. Your ophthalmologist will discuss your personalised wet AMD treatment programme.


What do injections of anti-VEGF medicine involve?

Anti-VEGF drugs like ranibizumab (Lucentis) and bevacizumab (Avastin) are injected into the eye to treat conditions where abnormal blood vessels leak fluid under the retina at the back of the eye. This leakage can cause vision loss. The injections aim to stop the blood vessels from growing and leaking, and to preserve central vision. This treatment is highly effective for many macular degeneration patients.

For the injection, you will lie comfortably while an ophthalmologist or registered nurse administers the drug into the back of your eye.

First, local anaesthetic drops are applied to numb your eye and minimise discomfort of the injection. Before your injection we clean the eyelids and around your eye with an antiseptic agent called povidone-iodine (PVP-I). Iodine is used for patients undergoing any type of eye surgery or procedure as it minimises the risk of infection. It is common to have sensitivity to iodine, so please view our frequently asked questions to find out more about our use of iodine. If you have any further questions, please ask your eye doctor or nurse practitioner.

Your face and the area around your eye will be covered by a small surgical drape to keep the area sterile. A small clip (speculum) will be used to keep the eye open (see picture below). The injection site is marked withcallipers and your eye is gently stabilised with forceps or a cotton bud. A few seconds later, the injection is given.

The drug is injected into your eye with a fine needle. Minimal discomfort is to be expected (equivalent to having blood taken from your arm). The procedure takes five to seven minutes, but the injection itself is over in less than 20 seconds. The injecting clinician will use lubricating drops after your injection. Your vision is assessed after you injection by checking you can see hand movements or can count fingers. 

Going home after your anti-VEGF treatment for age related macular degeneration (AMD)

The injecting clinician will use lubricants after the injection. There is no benefit in using antibiotic drops afterwards, so you will just be given lubricants to take home. You might notice some discomfort and redness for the first few days after your treatment, use the lubricants to provide some comfort after the injection. You may use them as often as necessary.

Please be aware that you might have to wait a short while to have your pressure checked before you leave.Your next appointment will be scheduled while you are with us or sent to you by post. Your GP will also be sent a letter after every visit.

There are no special precautions following intravitreal injections and you may travel, but please avoid getting water into your eye or swimming for the first few days.

However, if your eye becomes redder, sensitive to light, swollen and painful, or your vision gets worse after the anti-VEGF treatment for macular degeneration, you must seek medical help from an ophthalmologist. Thismight be a sign of infection, which would normally occur within the first week after the injection, with minimal risk.

Most people with wet AMD need injections several times a year. Many patients require a loading course of three injections at regular intervals of four weeks. After the first three courses of injections, most patients will continue to require further injections depending on the leakiness of your blood vessels.

You will need to be reviewed at regular intervals (the timings will be decided at each visit) to determine when further treatment might be given. This is to ensure that you continue to benefit from the treatment.

We provide treatment for AMD in several of our locations so that patients can get their care closer to home. 


What are the possible side effects of having injections in my eye?

Anti-VEGF eye injections carry a small risk of complications, mainly from the injection itself rather than the drug. For most patients, the benefits outweigh the small risk of injection injury. Significant vision loss from anti-VEGF injections is uncommon. Here are some common and rare side effects to be aware of:

Common side effects:

  • Red eye (there is usually a bleed or bruise on the white part of the eye at the site of injection, which clears in a week or two). 
  • Sore and gritty eye (slight ache and discomfort lasting a day or two).  
  • ‘Floaters’ or small specks in your vision might be seen for a few days after the injection.
  • Flashing lights or swirls of light immediately after the injection. 

Rare side effects:  

  • Serious eye infection (one in 2,000 cases).  
  • Retinal detachment. 
  • Increased eye pressure.  
  • Blood clots and bleeding in the eye.  
  • Inflammation inside the eye.  
  • Cataract formation.

Most of the discomfort relating to injections is due to the use of povidone iodine antiseptic. This is a vital part of the injection process and reduces the risk of infection. You may be sensitive to the iodine and so your injectingphysician will make sure to wash it out. Please note that allergies to iodine are extremely rare.

AMD treatment frequently asked questions

To help provide more information on AMD treatments, we have a list of our frequently asked questions. If you cannot find the answer to your question here, please contact our eye care experts who will be delighted to help you.

What will my vision be like after treatment?

Statistics for injections given directly into the eyes:

  • Nine out of 10 people report their vision stops getting worse.
  • Three out of 10 people report their vision improves.


Can I have treatment with anti- angiogenic (anti-VEGF) drugs if I am pregnant or breast-feeding?

If you are pregnant or planning to become pregnant, please discuss this with your doctor before your intravitreal injection treatment. Anti-VEGF medicines should be used with caution during pregnancy. Women of child-bearing potential should use effective contraception during their treatment and for at least three months after the last intravitreal injection. If you do become pregnant whilst undergoing intravitreal injections, pleaseinform your doctor immediately. Anti-VEGF medicines are not recommended during breast- feeding because it is not known whether the medicine passes into human milk. Ask your doctor for advice before treatment.


Who else should not be treated with anti- VEGF?

You should not be given anti-VEGF treatment if you have any of the following:

  • An allergy to anti-VEGF or any of its ingredients.
  • An infection in or around either eye or severe infection anywhere in your body.

Anti-VEGF should be used with caution in patients who have had a heart attack or stroke in the last three months, or who have uncontrolled angina or uncontrolled high blood pressure.

Please ensure you inform the doctor if there are any changes in your medical condition.


Can other medicines or food affect anti-VEGF treatments?

Anti-VEGF and certain other medicines can interact with each other. Some patients have developed a serious eye inflammation when receiving treatment with both anti-VEGF and verteporfin (Visudynephotodynamictherapy (PDT). To avoid this, tell your eye doctor about all the medicines you take, whether prescription or non-prescription medicines. This includes blood pressure medication, warfarin, aspirin, and vitamins. You must also inform the doctor if any medication has changed since your last visit.


How does an anti- VEGF injection prevent sight loss?

Anti-VEGF medicines stop the abnormal blood vessels growing, then leaking and bleeding under the retina.This prevents or limits damage to the retinal light receptors and loss of central vision. These medicines are effective in preventing further central vision loss in up to 90% of treated eyes.


Is anti-VEGF treatment right for me?

Your ophthalmologist will advise if the treatment is appropriate for you and which anti-VEGF medicine will be used. Only patients with active leaking of blood and fluid can benefit from it. The treatment that’s right for you will depend on the specific condition of your central retina (macula), your vision and whether there is scarring at the macula. We perform scans and photographs of the eye which show us the different layers of the retina. These scans can show us if there is blood or fluid present within the retinal layers and help us decide on your treatment.


Why is iodine used before my eye injection?

Using iodine before an intravitreal injection procedure means there is a minimised risk of infection (statistics at Moorfields Eye Hospital show an incidence of one in 3,000 cases). 


If I experience sensitivity to iodine does that mean I may be allergic?

All antiseptic agents/drops are known to cause mild to moderate irritation or some redness but that does not mean that you are allergic to them. Very rarely, patients are truly allergic to povidone– iodine. If you have any known allergy to povidone–iodine please tell your eye doctor when you attend the injection clinic appointment.


Why would I experience sensitivity to iodine?

Iodine is in the same group as chlorine (used as an antiseptic in swimming pools) and so it is likely that you will have a similar reaction to the eye irritation you may get from extended swimming.


Is there any preparation I can do to reduce iodine sensitivity?

It is common to have sensitivity to iodine and we make every effort to reduce possible irritation by thoroughly washing the iodine out of your eye. However, we advise that you use ocular lubricants before coming for your injections to reduce this sensitivity. Ocular lubricants are provided by us as part of your discharge care. 


Can an alternative antiseptic agent be used?

We can use another antiseptic agent like chlorhexidine gluconate for patients allergic or sensitive to povidone-iodine, however, although chlorhexidine is a good alternative antiseptic agent it is not as effective as povidone-iodine. This evidence is supported by clinical studies and recent Moorfields Eye Hospital post injection endophthalmitis data, which showed that there is a 10 times greater chance of risk of infection when using chlorhexidine. 

To prevent the risk of serious infection, our advice and policy is to use povidone iodine as an antiseptic agent rather than chlorhexidine.


What should I do if I am worried after my treatment?

Contact the following numbers:  

Moorfields retinal therapy department  on 020 7566 2311, Monday to Friday 8am-4.30pm

Moorfields pharmacy on 020 7566 2369, Monday to Friday 9am-5.30pm.  

Out of hours contact call 020 7253 3411 or visit our A&E at City Road, open 24 hours for eye emergencies only.


Where else can I get support for age related macular degeneration?

The Macular Society has information you might find useful. It also has a helpline on 0300 3030 111.


Age-related macular degeneration (AMD) treatment is available at Moorfields Private

You can self-fund or use private medical insurance to fund your treatment.

View Moorfields Private