#3: Anti-VEGF Therapy for Retinal Diseases

In 1994, a series of articles was published suggesting that vascular endothelial growth factor (VEGF) played a role in ocular neovascularization. Early animal studies showed that the injection of VEGF into the eye stimulated the growth and permeability of new vessels on the retina and also induced neovascular glaucoma.

A decade later, the first anti-VEGF molecule, bevacizumab, was approved in both the United States and Europe for the treatment of colon cancer in combination with chemotherapy. Because of the suspected role of VEGF in the development and progression of neovascular (wet) age-related macular degeneration (AMD), bevacizumab quickly began being used off-label by ophthalmologists.

In December 2004, the first anti-VEGF agent indicated for use in ophthalmology, pegaptanib, was approved by the US Food and Drug Administration. Its approval in Europe followed a year later. Pegaptanib was commonly used to treat wet AMD until the approval of ranibizumab in 2011 drove the market in a new direction.

The approval of ranibizumab, a monoclonal antibody that is a modified variant of bevacizumab, sparked a wave of comparative trials between these similar agents. Both the CATT and IVAN trials showed that ranibizumab and bevacizumab had equivalent effects on visual acuity in patients with wet AMD when administered according to the same schedule. Side effects, however, were more common in patients treated with bevacizumab.

Follow-up series of patient undergoing anti-VEGF therapy acquired with AutoRescan function of SPECTRALIS(R) OCT. Blood vessel alignment across all visits demonstrates precise rescan placement.

The newest anti-VEGF agent, aflibercept, was also introduced for the treatment of wet AMD in 2011 in the United States and a year later in Europe. Developed to improve the pharmacokinetics of VEGF binding, aflibercept typically requires less frequent dosing than other anti-VEGF antibodies.

In addition to their use in wet AMD, anti-VEGF agents are commonly used to treat diabetic retinopathy and retinal vein occlusions. Anti-VEGF agents have unquestionably revolutionized the treatment of retinal disease, demonstrating visual and anatomic outcomes that far outpace the performance of previously available treatments such as laser photocoagulation.

In preparation for and to assess the effectiveness of anti-VEGF agents in patients with retinal disease, ophthalmologists use a variety of diagnostic and assessment tools, including fluorescein angiography and optical coherence tomography.