Anti-VEGF therapy is usually a course of treatment. This is freely available on the NHS for wet or exudative age related macular degeneration, in severe cases of diabetic macular oedema and retina vein occlusion. Many patients would want to know the difference between having their treatment on the NHS or privately and if it may be worth having treatment privately.
What is Anti-VEGF Therapy?
Intravitreal injections means injection into the vitreous of the eye – this may be a course of anti-VEGF injections. Patients with several retinal conditions can lose their central vision when abnormal blood vessels bleed or fluid accumulates under the retina in the back of the eye.
A series of injections with anti-VEGF may be given into the back of the eye to stop blood vessels from growing and thereby controlling the fluid leakage. This treatment has been in use over the last decade and is known to be highly effective in preserving central vision in many people.
There are many different anti-VEGFs available. In general, there is treatment that is longer acting, of higher dosage and lasts longer, such as:
- Vabysmo (faricizumab)
- Eylea HD (aflibercept 8mg)
Various pivotal clinical studies have shown that a high proportion of patients (>50%) who were started on this treatment has been extended to beyond 12 weeks in wet AMD, diabetic macular oedema. There are other available anti-VEGF which have been licensed for over a decade, such as Eylea or aflibercept 2 mg, ranibizumab.
What Diseases are Treated with Anti-VEGF Therapy?
Conditions where intravitreal injection with Anti-VEGF may be used:
- Wet age-related macular degeneration
- Myopic choroidal neovascularization
- Diabetic macular oedema
- Retinal vein occlusion
- In some cases of central serous retinopathy
What Type of Anti-VEGF is available on the NHS or Privately?
Since early 2026, NHS England has commissioned the use of biosimilar aflibercept 2mg since the patient of the originator from Bayer has ended. The first line treatment for wet or exudative AMD, diabetic macular oedema and macular oedema from retina vein occlusion is now biosimilar aflibercept 2mg except in exceptional circumstances.
Depending on physician discretion, they may be switched to the higher dose treatment such as Eylea HD or vabysmo if certain criterias have been met.
Privately, medical retina specialists will choose the most suitable Anti-VEGF therapy dependent on clinical biomarkers and patient needs. There is availability of biosimilars, originator Anti-VEGF, high dose treatment including vabysmo and Eylea HD.
What are Biosimilar Drugs?
Biosimilar anti-VEGFs are highly similar, lower-cost versions of approved biologic eye medicines. Two biosimilars exist – Lucentis and Eylea 2mg. They are thought to function like the originator or reference drug – to stop abnormal blood vessel growth in retinal diseases. The safety and efficacy as the original “reference” products to treat wet AMD or diabetic macular oedema is found to be similar in several studies.
Review and Treatment Differences?
On the NHS, you may see a member of a team usually led by a consultant. This may be a fellow, trainee, optometrist or, in some places, nurse practitioners. They will be well trained to undertake the clinical review process. You may or may not see the same member at every review.
The intravitreal injection in most places on the NHS is now undertaken by nurse practitioners who have been trained to undertake intravitreal injections. They would have to undergo rigorous training processes before being allowed to inject a patient’s eyes independently.
Privately, you will be able to choose your appointment and your consultant. You will see the same consultant at every review who will monitor and follow you up closely. Your treatment will also be undertaken by the same consultant. So in complex cases, in cases requiring change or switch in treatment, you will have a dedicated review with a retina expert who will know your case well.
There will be costs to private anti-VEGF therapy that needs to be considered.
Ms Heng is an expert in retina conditions and was a sub investigator in several pivotal clinical trials in AMD and diabetic macular oedema. She has chaired several preceptorships for doctors from Arab and African nations, focussing on treatment in diabetes and macular degeneration. She takes a deep interest in personalised treatment and imaging biomarkers to optimise treatment and treatment outcomes for patients.
