Anti-VEGF Treatment May Increase Cataract Development Risk

Anti-VEGF injections are a workhorse therapy for improving and maintaining vision in many patients but this study found worrisome associations with premature cataract development. Photo: Leo Skorin, OD. Click image to enlarge. A recent study published in Ophthalmology on the association between anti-VEGF injections and incidence of cataract surgery has found that injection-receiving eyes are at greater risk of later requiring surgery, particularly in older patients.“The direct relationship between anti-VEGF injections and cataract development,” prefaced the authors in their paper on the work, “has not been clearly established,” prompting an exploration of how these factors affect one another. Patients were selected based on the presence of phakic lens status in both eyes, amounting to 603 patients in total. Their information—recorded over 15 years, between 2010 and 2025—was obtained through electronic medical records and followed for an average of 74 months to track progression. A total of 79.6% of the participants had wet AMD, while 20.4% presented with macular edema secondary to retinal vein occlusion; in addition, 225 patients had received cataract surgery, among which 194 (32.2% of the full sample of 603) were operated on in only the injected eye, eight (1.3%) in the non-injected eye and 23 (3.8%) in both eyes.Anti-VEGF injections were either bevacizumab, ranibizumab, aflibercept or brolucizumab administered in the form of three loading doses a month, followed by either an as-needed or treat-and-extend regimen as per typical protocols. Patients who received cataract surgery in the injected eyes did so at a nearly sixfold higher rate: 40.7% occurrence rate after 10 years, contrasted with 7.2% in the fellow, non-injected eye.The authors concluded that “eyes receiving repeated intravitreal anti-VEGF therapy were at a significantly higher risk of cataract surgery than their fellow eyes,” emphasizing dose-response relationship as a primary factor; they attributed this relationship to a variety of causes, with “inadvertent physical trauma to the lens or zonules during the injection procedure” playing a primary role, as well as intraocular inflammation (uveitis). Chronic uveitis is widely understood to be “a well-established risk factor for cataract development.”Further research is necessary to understand the extent of this relationship, though the authors’ present understanding of anti-VEGF injections’ correlation with cataract development and surgery points to potential flaws in the process of injection. Should this be the case, retina specialists should become more attentive to how they administer injections and adjust accordingly.Click here for the journal source. Choi J, Choi E, Kang SW, et al. Impact of intravitreal anti-vascular endothelial growth factor injections on cataract development. Ophthalmology. March 4, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.