Does combining radiotherapy with anti-VEGF therapy increase my risk of losing vision?
For neovascular (wet) age-related macular degeneration (AMD), the standard treatment is anti-VEGF injections, which block abnormal blood vessel growth. Some doctors have considered adding radiotherapy to reduce the number of injections needed. However, research shows that combining radiotherapy with anti-VEGF therapy actually raises the risk of losing vision, compared to using anti-VEGF alone.
What the research says
A 2025 systematic review and meta-analysis found that adding epimacular brachytherapy (a type of radiotherapy) to anti-VEGF therapy more than doubled the risk of losing 15 or more letters on an eye chart (a measure of significant vision loss) at both 12 months (relative risk 2.36) and 24 months (relative risk 2.39) 410. The same review also reported that vision outcomes were worse with the combination, with an average loss of about 1 to 2 lines on the eye chart compared to anti-VEGF alone 410. For stereotactic radiotherapy, the risk of vision loss was also higher, though the exact numbers varied 410. An earlier Cochrane review from 2020 also concluded that radiotherapy for neovascular AMD did not show clear benefit and could cause harm 9. These findings are consistent across multiple studies, suggesting that the combination is not safer than anti-VEGF monotherapy.
What to ask your doctor
- What is my current risk of vision loss with anti-VEGF injections alone?
- Are there any situations where adding radiotherapy might be considered for my specific case?
- What are the alternatives if I have trouble keeping up with monthly injections?
- How often will my vision be monitored if I continue with anti-VEGF therapy alone?
This question is drawn from common patient questions about Ophthalmology and answered using cited medical research. We do not provide individualized advice.