Reviewed for medical accuracy by Dr Evelyne Jonniaux, Medical Advisor
Last updated 28 September 2026
Anti-VEGF injections do not produce a lasting gain in vision. The gain is real in the first year, about 8 letters. At five years the mean has fallen 3 letters below baseline, 11 letters below the peak. The honest sentence is not “they restore sight”, it is “they slow a loss that continues”.
The questions we get asked
What do the injections actually gain?
The large American trial gives 8.0 letters with monthly bevacizumab and 8.5 with ranibizumab at one year. That figure underpins all the public messaging. Its five-and-a-half-year follow-up, in 647 patients, gives minus 3 letters against baseline, geographic atrophy in 41 percent of gradable eyes, and fluid on OCT in 83 percent. A cohort followed for 7.3 years finds macular atrophy in 98 percent of eyes.
Two caveats that point the optimistic way, and must be given: that five-year follow-up lost 29 percent of its living patients, and the seven-year cohort has only 65 patients. The true figures are likely worse, not better.
Are the two drugs equivalent?
The two large trials contradict each other, and not only in detail. With the same numerical gap, about 1.4 letters, the American trial concludes equivalence and the British trial concludes the result is inconclusive, purely because it had set a stricter margin. On safety, the first finds an excess of serious systemic adverse events with bevacizumab, the second does not. No affirmative wording is defensible.
Do supplements protect against macular degeneration?
The founding trial shows an effect of antioxidants plus zinc on progression to an advanced form, in people already affected by intermediate forms. Zinc alone and antioxidants alone are not significant. And the figure nobody quotes: in the low-risk group, the probability of progression at five years is 1.3 percent. There is almost nothing to prevent.
The second trial, often presented as a confirmation, is an add-on study: every participant was already receiving the formulation. Neither lutein, nor zeaxanthin, nor omega 3 reached significance. Its one retained result is the removal of beta-carotene, for an excess of lung cancers in former smokers.
Must a retinal detachment be operated within 24 hours?
It depends on one precise point: is the macula already detached. If it is, two series agree: no difference between under 48 hours and 3 to 7 days, then deterioration beyond 7 days. The useful window is six to seven days, not 24 hours. If it is not yet detached, the urgency is real, because the whole point is to operate before it detaches, and neither series covers that case.
These are retrospective studies. There is no randomised trial on surgical timing, for obvious ethical reasons.
And the success rate?
The “90 to 95 percent” in circulation is the final success, after repeat operations. Primary success of the first surgery, in a randomised European trial across 25 centres, runs from 53.4 percent with a scleral buckle to 72.0 percent with vitrectomy in eyes already operated for cataract. Redetachment runs from 20 to 40 percent. The distinction is crucial and almost always lost.
What the figures say
| Finding | Figure | Source |
|---|---|---|
| Visual gain at 1 year on anti-VEGF | 8.0 to 8.5 letters | CATT, N Engl J Med, 2011 |
| Same patients at 5 years | minus 3 letters against baseline | CATT, Ophthalmology, 2016 |
| Macular atrophy at 7.3 years | 98 percent of eyes | SEVEN-UP, Ophthalmology, 2013 |
| Progression at 5 years in the low-risk group | 1.3 percent | AREDS, Arch Ophthalmol, 2001 |
| Omega 3 on macular degeneration progression | no effect | AREDS2, JAMA, 2013 |
| Primary success of first detachment surgery | 53.4 to 72.0 percent | SPR trial, Ophthalmology, 2007 |
What Noria Health does, and does not do
We organise a retina consultation with a specialist team near Brussels, OCT and review of existing imaging included, and confirm feasibility within 24 to 48 hours.
We do not handle any acute situation. A shower of floaters, flashes, or a curtain rising across the field of vision need same-day examination: that is exactly the case where the macula may not yet be involved, and where every day counts. Do not wait for a reply from us.
Who reviewed this page
Noria Health editorial team.
See also: all our articles on ophthalmology.
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