Injections to Stop Bilateral Vision Loss

Macular degeneration can affect both eyes simultaneously. Injections of medication can slow and reverse this condition.
At the University of Iowa, about 12% of our patients have bilateral, simultaneously active, wet AMD. Because the standard treatment protocol is an injection every 4 to 6 weeks, these patients would be required to return for an injection on average, every 2 to 3 weeks if only 1 eye was treated at a time. This frequency of visits places significant burdens on patients, family, or friends. The burdens include the cost of transportation, time away from work, and copayments. 

We began offering bilateral intravitreal injections on the same visit. Bilateral intravitreal injection on the same day is a controversial topic among vitreoretinal specialists. In our 2011 study published in the journal RETINA, we found that bilateral injections of antivascular endothelial growth factor agents on the same day were safe. They did not increase the rate of adverse events and were preferred by the majority of patients.

One hundred and two patients received an average of 4.43 bilateral injections (range 1–13). A case–control group of 102 patients received an average of 10.2 unilateral injections, (range 2–28). Bevacizumab was injected 45.5%, ranibizumab 45.5%, and a combination of bevacizumab and ranibizumab 9% of the time for bilateral injections. Bevacizumab was used 50.3% and ranubizumab 49.7% of the time in unilateral injections. The follow-up of both groups averaged 18.4 months (range 4.7–36.5 months). There were no cases of endophthalmitis or cerebrovascular accident in either group. There was a single case of myocardial infarction in each group. There were two deaths in the bilateral group and three deaths in the unilateral group. More than 90% strongly preferred bilateral injections to unilateral injections.