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What is Avastin® (bevacizumab)?

There are two kinds of age-related macular degeneration (AMD): dry AMD, in which light-sensitive photoreceptors and supporting retinal pigment cells in the macula break down; and wet AMD, in which abnormal blood vessels grow under the retina that can leak or bleed, causing damage.1 This growth of abnormal blood vessels can also occur in myopic macular degeneration (MMD).2 Though AMD and MMD are not curable, there are treatments to help slow progression of the disease and preserve existing vision.

What is anti-VEGF therapy?

One of these treatments involves eye injections with medications known as anti-VEGF drugs. Anti-VEGF drugs bind or trap VEGF, which is a protein that stimulates the growth of blood vessels. When VEGF is produced in the eyes, it not only promotes the growth of new blood vessels, but these vessels tend to be abnormally weak and prone to leakage, which can cause damage to the retina and loss of vision.3 There are several anti-VEGF medications used in the treatment of AMD and MMD – while Avastin is not FDA-approved to treat wet AMD or MMD specifically, many studies have demonstrated that it is safe and effective in the eye, and therefore it is used off-label by many retina specialists to treat wet AMD and MMD.

What is Avastin?

Avastin® is the brand name of the anti-VEGF drug bevacizumab. It is a clear solution that comes in various strengths, usually, the 25mg/ml vial is used, typically only a small amount of this medication is extracted from the vial (0.05 mL) for injection into the eye.

How does Avastin work?

Avastin is given as an intravitreal injection in your doctor’s office. The drug binds and inhibits VEGF, preventing it from promoting abnormal blood vessel growth. This helps to preserve your existing vision and slow the progression of wet AMD or MMD.

What are the possible side effects of Avastin?

Any treatment or medication has the potential to cause side effects. While some people might experience side effects, others might not. Prior to starting Avastin, tell your eye doctor about any medications or supplements you’re taking in order to avoid any adverse interactions.

Common side effects

Common side effects can include:

  • Eye pain or irritation
  • Eye redness
  • Floaters (temporary)
  • Mild blurred vision (for a day or two)

Serious complications

More serious complications may include:

  • Retinal detachment
  • Infection
  • Vitreous hemorrhage (bleeding inside the eye)
  • Increased intraocular pressure
  • Blood clots or stroke

If you notice any atypical symptoms after treatment with Avastin, call your eye doctor immediately.

Things to know about Avastin

Avastin is an anti-VEGF drug that is used off-label to treat wet AMD and MMD. This means that the drug is used in a way that is not specified in the drug’s packaging information, which has been approved by the Food and Drug Administration (FDA). Simply put, Avastin is not approved by the FDA to treat AMD or MMD, although many studies have shown that it is safe and effective for treating AMD and MMD. This has been slightly controversial, because while Avastin has been shown to be as effective as Lucentis® for treating AMD and MMD, Lucentis costs approximately 50 times more than Avastin.4,5

Talk to your doctor

Your doctor might use Avastin off-label in order to be more cost efficient. Talk with your doctor about the reasons they might want to prescribe Avastin instead of a drug that is approved by the FDA, and the possible drawbacks of doing so (for example, will your insurance cover it, what are the risks and benefits, and so forth).

Dosing information

Avastin intravitreal injections are typically given every 4-6 weeks; some studies involving Avastin administered the injections every 4 weeks.4,5 The standard dose is 1.25mg in 0.05mL for adults.6 Your eye doctor may choose to change your treatment regimen depending on treatment response; talk with your doctor about what dosing regimen might be best for you.7

Written by Jaime R. Herndon | Reviewed September 2019
  1. National Institutes of Health: National Eye Institute. Facts About Age-Related Macular Degeneration. 2015. https://nei.nih.gov/health/maculardegen/armd_facts. Accessed November 12, 2018.
  2. Dunaief J. Myopic Macular Degeneration. BrightFocus Foundation website. 2018. https://www.brightfocus.org/macular/article/myopic-macular. Accessed February 4, 2019.
  3. American Macular Degeneration Foundation. Macular Degeneration Treatments. n.d. https://www.macular.org/treatments. Accessed November 12, 2018.
  4. Berg K, Hadzalic E, Gjertsen I, Forsaa V, Berger LH, Kinge B, et al. Ranibizumab or bevacizumab for neovascular age-related macular degeneration according to the Lucentis compared to Avastin study treat-and-extend protocol: Two-year results. Ophthalmology. 2016; 123(1): 51-9. Doi: 10.1016/j.ophtha.2015.09.018. Accessed November 13, 2018.
  5. Karth P. Bevacizumab. American Academy of Ophthalmology EyeWiki. 2017. http://eyewiki.aao.org/Bevacizumab#Administration_and_Dosing. Accessed November 13, 2018.
  6. Jansen RM. The off-label use of medication: The latest on Avastin-Lucentis debacle. Med Law. 2013; 32(1): 65-77. https://www.ncbi.nlm.nih.gov/pubmed/23781765. Accessed November 13, 2018.
  7. Avastin prescribing information. (2018). https://www.gene.com/download/pdf/avastin_prescribing.pdf. Accessed November 13, 2018.