- Reference Number: HEY1582/2025
- Departments: Ophthalmology Department
- Last Updated: 30 June 2025
Introduction
This guide is designed to help you understand the ‘Treat and Extend’ pathway for your anti-VEGF eye injections. It aims to answer common questions you may have about your treatment.
What is the ‘Treat and Extend’ Pathway?
The “Treat and Extend” pathway is a method used to give anti-VEGF (vascular endothelial growth factor) injections to patients with certain eye conditions. It aims to keep your vision stable while reducing the number of clinic visits and injections over time.
What eye conditions are treated with this pathway?
The ‘Treat and Extend’ anti-VEGF injection pathway is commonly used for conditions such as:
- Wet Age-Related Macular Degeneration (wet AMD): This is the most common condition treated with this pathway.
- Diabetic Macular Oedema (DMO): Swelling of the macula due to diabetes.
- Retinal Vein Occlusion (RVO): Blockage of a vein in the retina leading to macular swelling.
- Myopic Choroidal Neovascularisation (mCNV): Growth of abnormal blood vessels in individuals with high short-sightedness.
Your eye doctor (ophthalmologist) will have diagnosed your specific condition and determined that this treatment approach is suitable for you.
How does the ‘Treat and Extend’ approach work?
Here’s how it generally works:
Loading Phase: You will typically start with a series of injections at fixed intervals, often monthly (e.g., for the first 3 months). This is to get the condition under control and dry out any leakage in the retina as much as possible.
Extension Phase: If your eye responds well and your vision is stable with no signs of active leakage (as seen on your eye scans), the time between your injections will be gradually increased. For example, your next appointment might be scheduled for 6 weeks or 8 weeks, and so on. You will still receive an injection at each of these visits.
- If your eye continues to remain stable and dry, the interval to your next injection may be extended further, up to a maximum interval (e.g.12 or 16 weeks), depending on the specific drug and your condition).
- If the scan shows that your condition has worsened or fluid has returned, the interval between injections will be reduced to a previous interval where your eye was stable. In some cases, if there’s a significant worsening, you might go back to monthly injections for a period.
The goal is to find the longest possible interval between injections that keeps your eye condition stable, and your vision preserved, minimising the number of injections and hospital visits you need over time.
Monitoring phase– If your condition stays stable over three 16-week interval, we may pause injections and move to monitoring only. You will still have regular check-ups with vision checking and OCT scans. If there is any sign of worsening, treatment will restart promptly. The main goal is to catch any problems early so we can act quickly to protect your vision.
How many injections will I need and for how long?
The number of injections varies between individuals. Many people require long-term treatment to maintain their vision. The goal is to reduce injection frequency once stability is achieved.
What are the benefits of this pathway?
- Personalised Treatment: The treatment schedule is tailored to how your individual eye responds.
- Reduced Treatment Burden: Compared to having injections at fixed monthly intervals, ‘Treat and Extend’ often means fewer injections and hospital visits over the long term, once your condition is stable.
- Maintained Vision: The aim is to keep your vision stable and prevent further loss, similar to other treatment regimens.
- Proactive Approach: You receive an injection at every visit during the extension phase, which aims to prevent flare-ups of the condition rather than waiting for them to occur.
What happens during a ‘Treat and Extend’ appointment?
Your appointments will typically involve: Each visit may include:
- Vision Test – checking your eyesight using a letter chart
- OCT Scan – a quick, painless scan to check for fluid in the retina
- Injection – You’ll receive your anti-VEGF injection. You will be able to go home after the injection procedure.
- Review –Later on, your scan and vision will be reviewed by specialist ophthalmic practitioners and the decision will be made regarding further injection interval and your next injection appointment will be booked at that interval. You will be sent a letter of appointment informing you of date of your injection.
What if I miss an appointment?
Anti-VEGF treatment works best when given consistently, and missing injections may lead to a decline in your vision. This treatment does require commitment, but we’re here to support you every step of the way. If you have any concerns or difficulties, please let us know so we can help. If you have registered your mobile number with us, you will receive a text message informing you of the interval till their next injection which will help you with planning other commitments.
Can I stop treatment?
In some cases, if your condition remains completely inactive for a very long period at the maximum extended interval, your ophthalmologist might discuss the possibility of pausing treatment and monitoring your condition closely. However, for many people, ongoing treatment is necessary. We also stop treatment if the treatment does not prove to be effective. Please do not stop your treatment without discussing it with your eye doctor
Who can I contact if I have more questions?
If you have any further questions or concerns about your ‘Treat and Extend’ anti-VEGF injection pathway, please do not hesitate to speak to your ophthalmologist, the specialist nurses, or other members of the ophthalmic team at your clinic. Below are the contact details of local and National support services including contact of our Eye Clinic Liaison Officer.
What should I do if I notice a reduction in my vision?
If you notice any of the following before your scheduled appointment:
- Blurred or distorted vision
- A dark patch in your sight
- A drop in vision
- Or if you’re worried about your eyes for any reason
Please contact us straight away for an urgent review through Eye Urgent Care Clinic tel: 01482) 816658 or tel: 01482 608788 (8.30 am to 5.00 pm) or Out-of-Hours tel: 01482 604346 (Please listen to full voice message on how to access emergency out of hours service).
Do not wait for your next appointment
Final note
This guide offers general information. Your condition and care plan are unique, and your eye care team is best placed to provide specific advice for you.
Support Services
- Eye Clinic Support Service (ECLO)
- Sight Support Centre
466 Beverley Road, Hull, HU5 1NF
- Macular Society
PO Box 1870, Andover, SP10 9AD
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.
