Anti-VEGF injections are the standard treatment for wet macular degeneration, diabetic macular edema and macular swelling after a retinal vein occlusion. They work, but they are expensive and they are not a one-time fix. Most people need a series of injections, often every month or two at first, and many keep needing them for years.
That combination shapes everything about getting them abroad. The price gap between drugs is huge, and the cheapest one has strong trial evidence behind it. But a flight for each injection rarely makes sense. Treatment abroad tends to work only when you will actually be living near the clinic for months at a time.
What anti-VEGF injections treat and why they repeat
VEGF (vascular endothelial growth factor) is a protein that drives the growth of leaky, abnormal blood vessels and fluid buildup in the retina. Blocking it dries the macula and protects central vision. The drug is injected into the eye in an office procedure after numbing drops and an antiseptic wash. It takes minutes.
The three main conditions treated are:
- Wet (neovascular) age-related macular degeneration (AMD). Abnormal vessels grow under the retina and leak or bleed.
- Diabetic macular edema (DME). Fluid collects in the center of the retina in people with diabetic retinopathy. The American Diabetes Association's 2026 Standards of Care call anti-VEGF injections first-line treatment for most eyes with center-involving DME that affects vision.1
- Retinal vein occlusion (RVO). A blocked retinal vein causes swelling in the macula.
The effect of each injection wears off. That is why treatment is a schedule, not an event. In US Medicare alone, more than 2.5 million intravitreal injections were billed in 2015, by more than 3,000 ophthalmologists.2 Common regimens include fixed monthly dosing, "as needed" dosing after monthly checks, and "treat and extend," where the gap between injections grows while the eye stays dry. One clinical case in a 2025 Review of Optometry article shows how this plays out: a patient started on injections every four weeks and was later extended to six.3 Your own interval depends on how your eye responds, and only your retina specialist can set it.
The drugs: Avastin, Lucentis, Eylea, Vabysmo and biosimilars
Several drugs do the same basic job. They differ in price, regulatory status, and how long each dose may last.
| Brand (generic) | Status for eye use | What to know |
|---|---|---|
| Avastin (bevacizumab) | Off-label in the US; approved as a cancer drug | Repackaged or compounded into small eye doses. By far the cheapest option.2 |
| Lucentis (ranibizumab) | FDA-approved for eye disease | Biosimilars Byooviz and Cimerli are FDA-approved.3 |
| Eylea (aflibercept) | FDA-approved for eye disease | Five aflibercept biosimilars were FDA-approved in 2024, three designated interchangeable.3 |
| Vabysmo (faricimab) | FDA-approved January 2022 for wet AMD and DME | Described by its maker as the first bispecific antibody for the eye.4 A prefilled syringe was approved in 2024 for AMD, DME and RVO.5 |
What "biosimilar" and "interchangeable" mean for you
A biosimilar is a near-copy of a biologic drug, approved after showing no meaningful clinical difference from the original. Byooviz was the first FDA-approved anti-VEGF biosimilar, in 2021, and Cimerli followed in 2022 as an interchangeable biosimilar to Lucentis.3 Byooviz later gained interchangeable status too.6 Interchangeable is a US legal designation about substitution at the pharmacy; it is not a separate quality grade.
Biosimilars usually cost less than the original, but don't expect generic-style savings. The Review of Optometry article notes that the gap is often smaller for biosimilars than for ordinary generics, because these drugs are made in living cells.3
The bevacizumab question
Bevacizumab is used off-label because an eye-specific version has not been FDA-approved. An ophthalmic bevacizumab (Lytenava, bevacizumab-vikg) was approved in the EU and UK in 2024 but, as of that April 2025 article, not in the US.3 Because eye doses are prepared by splitting a larger vial, the quality of the pharmacy that does it matters. Ask any clinic, at home or abroad, where its bevacizumab is prepared and how.
What anti-VEGF injections cost in the US
Exact US prices move every quarter. Medicare pays for these drugs under Part B based on the manufacturer's average sales price, and your bill also includes the injection procedure and the exam or scan done at the visit. The per-dose drug figures below are older published estimates. They are useful for the scale of the gap, not as today's price.
These ranges come from an American Academy of Ophthalmology report on Protocol T, which put the drugs at about $50, $1,200 and $1,950 per dose,7 and from a JAMA Ophthalmology Medicare analysis summarized by Ophthalmology Times, which used $60, $1,170 and $1,850.2 Faricimab was not on the market when either was published, and we could not find a current, citable per-dose price for it.
With Medicare Part B you generally pay 20% coinsurance after the deductible unless you have supplemental coverage, and that share adds up across a year of injections. The 2025 Review of Optometry article estimated that if off-label bevacizumab disappeared and patients moved to the on-label branded product, a patient's share per injection would rise from about $18 to about $190.80.3 That is the core reason people look abroad: not one big bill, but a steady stream of smaller ones.
Ask your US retina office for the drug billing code it uses, the total allowed amount per visit (drug plus injection plus imaging), and what you personally owe under your plan. Compare that against any quote abroad line by line.
Do the cheaper drugs work as well?
Two large US clinical trials compared the drugs head to head.
| Trial | Condition | Main finding |
|---|---|---|
| CATT (published 2011) | Wet AMD | Ranibizumab and bevacizumab had equivalent effects on visual acuity.8 |
| DRCR.net Protocol T (NEJM, 2015; 660 patients) | DME | With milder vision loss (about 20/32 to 20/40), all three drugs gave similar one-year gains: 8.0 letters for aflibercept, 7.5 for bevacizumab, 8.3 for ranibizumab. With 20/50 or worse, aflibercept gained more: 18.9 letters vs 11.8 for bevacizumab and 14.2 for ranibizumab.7 |
Taken together, the trials support bevacizumab as a reasonable starting drug for many people with wet AMD and for DME with better baseline vision. People with worse baseline vision from DME may benefit from aflibercept. CATT and Protocol T did not include faricimab or the biosimilars. Your retina specialist will weigh your scans, your vision and how you respond. Switching drugs mid-course is common and is a medical decision, not a cost-only one.
Anti-VEGF injections in Colombia: what we could and couldn't verify
We want to be plain here. We could not find a public, citable source listing current per-injection prices for any of these drugs in Colombia, and we could not confirm the Colombian registration status of each brand and biosimilar from an official source. So this guide gives no Colombian price range. Any figure you see quoted elsewhere should come with the drug name, the dose and what the visit includes.
What we can say:
- Every medicine sold in Colombia needs an INVIMA registro sanitario. Ask the clinic for the brand, the manufacturer and the registro sanitario number of the exact product it will inject. You can check it in INVIMA's public registry.
- Colombia regulates some drug prices. The national medicines price commission (CNPMDM) publishes lists of drugs under direct price control, with maximum wholesale prices per presentation. Circular 013 of 2022 is one example.9 We could not confirm whether any anti-VEGF drug is on the current list.
- Bevacizumab preparation still matters. Ask who splits the vial, under what sterile conditions, and how long doses are stored before use.
The core problem: injections are a series, not a trip
A cataract or LASIK trip is one procedure and a short recovery. Anti-VEGF treatment is the opposite. You need regular exams and imaging (usually OCT scans) to decide whether to inject, and you need them on time.
Missed visits carry real risk. In a study summarized by AAO EyeNet, patients with proliferative diabetic retinopathy were lost to follow-up for more than six months after treatment. Among eyes treated with anti-VEGF alone, 10 of 30 had a retinal detachment at the final visit, versus 1 of 46 eyes treated with laser. The authors noted that the study was not randomized.10 That study was in diabetic retinopathy, not AMD, but the lesson carries over. When the drug wears off and no one is watching, the disease comes back. (For what detachment repair involves, see our guide to retinal detachment surgery options.)
Where it can work
- You live in or near Medellín, Bogotá or another city for months at a time
- You are an expat or long-stay retiree with local care already set up
- You split the year and can arrange care at both ends
- Your doctor has you on a stable, extended interval
Where it usually doesn't
- Flying in for each injection from the US or Canada
- A new diagnosis that still needs monthly loading doses
- Active bleeding, new fluid or a recent vision drop
- No plan for who sees you if you get delayed
Paying for a series of injections abroad
Ask for a written quote per visit, not per injection, because the exam and scan are part of each visit. Then ask how prices work if your plan changes, for example if you need to switch drugs or come more often.
Clinics usually take a card or a bank transfer. A card is easy but may add a foreign-transaction fee and a poor exchange rate. Paying in local currency through a transfer service such as Wise can make repeat payments cheaper and easier to track, and a bank wire is another option. Keep every receipt with the drug name and dose on it. Your home insurer or tax preparer may want them.
Questions to ask before your first injection abroad
- Which drug will you use, which manufacturer, and what is its INVIMA registro sanitario number?
- If bevacizumab, where and how is the dose prepared, and how is it stored?
- What does each visit include: exam, OCT scan, injection, both eyes?
- What is the price per visit in writing, and does it change if you switch drugs?
- What schedule do you expect for me, and how will you decide to extend or shorten it?
- Who do I call, day or night, if I have pain, worsening redness or a sudden vision drop after an injection?
- Will you send my OCT images and injection log, in English, to my home retina specialist?
- What happens to my schedule if I have to leave the country early?
Our general questions to ask an eye surgeon abroad and the eye surgery abroad safety checklist cover credentials and facility checks that apply here too. If you want help comparing retina clinics for a long stay, you can request provider options.
Increasing pain, worsening redness, light sensitivity or a drop in vision in the days after an injection can mean infection inside the eye. That needs same-day care, wherever you are.