Anti-VEGF is a common treatment for wet age-related macular degeneration (wet AMD) that involves injecting medication directly into your eye. That may sound scary or stressful, but there are steps you can take to help manage your anxiety about this treatment.

Vascular endothelial growth factor (VEGF) is a protein that creates new blood vessels when your body needs them. If cells make too much VEGF, however, it can lead to the formation of abnormal blood vessels. In wet AMD, these blood vessels can grow into your eye and leak fluid or blood, which can damage your central vision.

Your doctor may prescribe anti-VEGF therapy to help slow vision loss caused by wet AMD. During the treatment, your eye doctor may:

  • clean the eye to avoid infection
  • administer a numbing medication to ease any pain
  • put a small device on your eye to keep the eyelids open
  • inject the medication into the white part of your eye with a thin needle

The injection should only take a few seconds. Your doctor might suggest additional treatments or other therapies along with the anti-VEGF therapy.

Although complications are rare, you might feel some fear or anxiety about this treatment. You could also experience difficult emotions or mental health challenges related to vision loss.

Read on to find strategies for managing these challenging emotions during your treatment.

Anti-VEGF therapy may help slow vision loss, which can benefit both your physical and mental well-being.

But it’s natural to experience some concerns, anxiety, or other challenging emotions about anti-VEGF therapy.

“Feeling nervous before any medical procedure is completely normal, so patients should know they are not alone,” said Abdhish R. Bhavsar, MD, a spokesperson for the American Academy of Ophthalmology (AAO) and an ophthalmologist at Retina Consultants of Minnesota.

A 2022 review found eight studies on anti-VEGF therapy that reported results related to mental health. Most of those studies found overall mental health improvements within 3–12 months of someone starting anti-VEGF therapy. It’s not clear whether the treatment itself or other factors led to mental health improvements.

The review also identified several concerns about anti-VEGF therapy among people with wet AMD, including:

  • fear of getting an injection into their eye
  • fear that the injection may damage their eye
  • fear that their condition or vision may get worse
  • uncertainty about how well the treatment would work
  • anxiety while waiting in the clinic before an appointment

Sometimes fear or anxiety about anti-VEGF may stop someone from getting treatment.

A 2022 study of 49 people with wet AMD and 46 people with diabetic macular edema (DME) patients, as well as 47 wet AMD and 33 DME caregivers, found that:

  • 79% of patients and caregivers found their routines were disrupted before, the day of, and after the anti-VEGF injection
  • 54% of patients and 42% of caregivers found it harder to follow the treatment plan due to injection-related fear or anxiety

Some people may find their stress is eased after their first injection, while others may continue to feel apprehension about the procedure.

The strategies below may help you manage fear, anxiety, or other challenging feelings about anti-VEGF therapy.

Find a doctor you trust

Having a positive relationship with your eye doctor may help you feel more comfortable with your treatment plan.

In the previously mentioned study of people with wet AMD and DME, 70% said that their relationship with their doctor was the most important factor in helping them follow their treatment.

If your doctor second-guesses you repeatedly, expresses doubts about your symptoms, or implies you are exaggerating your pain level, you may be experiencing medical gaslighting. Consider looking for a different eye doctor if you don’t feel comfortable with your current one or you’re dissatisfied with your care.

Learn more about the treatment

Learning about the potential benefits and risks of anti-VEGF therapy may help you feel better about the procedure.

“Anti-VEGF medication is very successful at protecting eyesight among patients with vision-threatening diseases like diabetic retinopathy or some types of macular degeneration,” said Bhavsar. “For the vast majority, it at least slows down vision loss.

“Complications from anti-VEGF treatments are not common. The most serious risks occur in much less than 1% of patients,” he explained, “and include the risk of retina tear or detachment and endophthalmitis, [which is a] severe infection inside the eye.”

You might also find it helpful to learn more about the specific steps involved in anti-VEGF therapy.

“It’s very common to be nervous about getting an eye injection, [but] many patients feel better once they understand what they should expect,” said Bhavsar. “An educated patient is a confident patient.”

Consider asking your doctor to describe the treatment procedure from start to finish.

Information and videos from the AAO can also help you learn more.

Practice relaxation techniques

Practicing relaxation techniques before each treatment may help calm your body and mind, said Michael C. Smith, PhD, a licensed clinical psychologist who consults with The Chicago Lighthouse to support blind people and those with visual impairments.

“When they go in to get the shot, I encourage clients to practice progressive muscle relaxation, which physiologically helps lower your experience of anxiety,” Smith said.

To perform progressive muscle relaxation, start by sitting or lying in a comfortable position and consciously relaxing your body. Then tense your toes for about 5 seconds before relaxing again. Next, tense and relax your calves, then your thighs, and so on, until you’ve tensed and relaxed every muscle group in your body.

Other relaxation techniques, such as deep breathing or guided imagery, may also help reduce stress and promote relaxation. Smith recommends practicing your chosen technique at home before your first treatment session.

Give yourself a reward

Promising yourself an immediate reward after each treatment session may give you something to look forward to while reinforcing the efforts you’re making to manage your condition.

“There’s a lot of challenging stuff that people with vision loss have to do and learn, and we want you to feel good about the efforts you’re making,” Smith said. “So be intentional about giving yourself a reward after it’s done.

“I encourage people to have some concept of what their reward is going to be. Think ahead of time, ‘I’m going get a latte when I’m done because there’s a coffee shop in the clinic,’ or whatever,” he added.

Ask about anti-anxiety medication

If you’re experiencing a high level of anxiety about anti-VEGF therapy, your doctor might prescribe anti-anxiety medication to take before treatment sessions.

Anti-anxiety medications may cause certain side effects, and your doctor will only prescribe this treatment if they believe the benefits outweigh the risks for you.

They may encourage you to try other strategies to manage anxiety first.

Support your overall mental health

Vision loss from wet AMD may cause grief, anxiety, or other challenging emotions. These changes may also affect your sense of self, social well-being, or relationships.

Taking steps to support your mental health overall may help you cope with increased anxiety or stress from anti-VEGF therapy or other challenging experiences.

“The general idea is to find effective tools to handle anxiety and make that part of your daily living,” explained Smith. “If we get your baseline anxiety down, then when events occur that you’re going to feel more anxious about, it doesn’t go up quite as high and is easier to recover from.”

Consider asking your doctor for a referral to a mental health specialist who has experience supporting people with vision loss. Some vision clinics have mental health specialists on staff.

Your doctor or mental health specialist may recommend counseling, support groups, or other resources and strategies to help you manage the emotional, social, and psychological challenges of vision loss.

They may also prescribe medication or other treatments if you have a mental health condition, such as anxiety or depression.

Anti-VEGF therapy can help limit vision loss from wet AMD and may even improve vision in some people with this condition. This might have benefits for your physical and mental well-being.

It’s not unusual for you to experience challenging emotions about anti-VEGF therapy. Getting injections into your eye can be nerve-wracking. You might also feel fear or uncertainty about how your condition or vision will change after treatment.

Talking with your doctor about the potential benefits, risks, and steps involved in anti-VEGF therapy may help you feel more prepared and less anxious.

You might also find it helpful to practice relaxation techniques before each procedure and rewarding yourself afterward.

Taking steps to support your overall mental health is also important. Consider asking your doctor for a referral to a mental health specialist who has experience supporting people with vision loss.

Sometimes your doctor might also prescribe anti-anxiety medication or other treatments for mental health challenges.