Symptoms of Wet Age-Related Macular Degeneration

Symptoms of wet age-related macular degeneration (AMD) commonly include trouble reading with distortion in vision, which can be present in one eye. Wet AMD is often seen as a progression from dry AMD.

Anatomy

To fully understand the symptoms of wet AMD, it’s important to be aware of a few of the basic anatomy and physiology terms pertaining to the eye. These include the following.

• Sclera: Also known as the white of the eye, the sclera functions as an outer protective layer.
• Lens: Located in the front of the eye, this structure focuses images on the retina.
• Retina: Located in the back inner wall of the eye, the retina is made up of special nerve cells that react to light. The specific part of the retina that is around the area of central vision is called the macula. This is where the eye focuses the images that we see.
• Choroid: The vascular (containing blood vessels) layer of the eye that lies between the retina and the sclera.
• Macula: Enables vision in sharp detail (allowing a person to see small details such as reading fine print) in a person’s direct line of sight.

Progression to Wet AMD

There are two forms of AMD: the dry and the wet form. Dry AMD causes thinning of the macula and results in symptoms of blurred vision and reduced central vision.

The wet form is a result of abnormal growth of blood vessels. These abnormal blood vessels, which form under the macula, can leak fluid and blood into the eye. Wet AMD, which can progress very quickly, may cause extreme vision problems (such as blind spots or loss of central vision.

In approximately 10% to 15% of those with AMD, the condition will progress to wet AMD. Most of the time, a person first has dry AMD, which develops, in time, toward the wet form of the condition.

In wet AMD, new blood vessels grow abnormally in the vascular, choroid layer of the eye. This is referred to as choroidal neovascularization. These new, abnormal vessels are naturally weak and fragile, and therefore leak fluid and blood.

The leakage accumulates in the layers of the retina (including the macula) and can end up causing scarring, which damages the retinal cells. The retinal cells then stop functioning normally, and vision is reduced.

Frequent Symptoms

When wet AMD first begins, there may not be any symptoms at all. In fact, the condition may not be detected until it worsens, or when it impacts both eyes. This is because, early on, the unaffected eye can compensate for the affected eye.

Symptoms of wet AMD may begin with a slight blurring of the central vision (both close and far away). As the condition progresses, the area of blurriness becomes larger. Next, blind spots may develop, and you may have trouble seeing fine details clearly.

Other symptoms of wet AMD may include:

• Noticeable symptoms when one eye is closed
• Distorted vision (straight lines may appear bent or wavy)
• Difficulty reading
• Trouble seeing details in low light
• Difficulty reading, driving, and seeing the television
• Trouble recognizing faces
• Reduced central vision in one or both eyes (this may occur rapidly, sometimes within days or weeks)
• A well-defined blurry or blind spot in the center of the field of vision caused by scar tissue (this is an advanced symptom of wet AMD); the blind spot can appear to be gray, red, or black
• Rapid progression (worsening) of symptoms

Some people do not notice the symptoms at all in the initial stages of the condition unless they close their good eye. This is one reason that having regular eye exams is so important, particularly if you have the dry form of AMD, because it can progress to the wet form of the condition very quickly. 

Rare Symptoms

There are several symptoms of wet AMD that are considered rare or uncommon. These include the following.

• Changes in color perception: Color may appear less intense when seen with one eye than with the other eye. This can occur when wet AMD affects just one eye.
• Delayed dark adaptation: A symptom that involves an increase in the time it takes to adapt to seeing in the dark after environmental light changes occur. This happens due to the retina taking longer to adapt to changes in the brightness of light.
• Flashing lights: Seen in the central field of vision, the perception of flashing lights is caused by the new blood vessels or scar tissue pulling on the retina. Note, if you see flashing lights in the peripheral (side) vision, this may be due to causes other than wet AMD.
• Dark or black spots on white walls: Upon waking up in the morning in some people with wet AMD, a person will see dark spots or areas that are not there. Interestingly, these symptoms are only noticed when looking at a white background, such as a white wall. This can be caused by areas of wet macular degeneration or from atrophy (shrinkage) of the retina.
• Visual hallucinations: The loss of central vision from wet AMD may result in a condition called Charles Bonnet syndrome, which includes symptoms of visual hallucinations. Sometimes people are reluctant to talk about hallucinations when they are unaware of the fact that these can be associated with AMD and not necessarily linked to mental illness.

Complications

Several potential complications can occur as a result of wet AMD. These include Charles Bonnet syndrome, retinal detachment, risk for falls, and mental health problems such as depression.

Charles Bonnet Syndrome

This is a rare disorder that results in visual hallucinations (seeing things that are not there). Charles Bonnet syndrome is more likely to occur during the advanced stages of AMD/retinal disease.

Retinal Detachment

In this condition, the retinal tissue separates from the blood vessels that provide oxygen and nourishment to the nerve cells of the retina. Retinal detachment can cause vision loss.

Symptoms include blurry vision, floaters (spots in your vision), flashes of light, and reduced peripheral (side) vision. If you have any symptoms of retinal detachment, you should see your healthcare provider right away.

Depression

When a person loses the ability to see, it dramatically impacts many areas of life, including independence, work, hobbies, social interaction, and more. In some instances, this can lead to depression, particularly for those who lack a significant support system, such as supportive friends or family. Common symptoms of depression include:

• Loss of appetite
• Loss of interest in things you used to enjoy, such as hobbies
• Low energy level
• Difficulty concentrating
• Self-esteem problems
• A change in sleep pattern
• Persistent sadness
• Thoughts of suicide

Falls and Injuries

The loss of clear vision can lead to a high risk of falling, particularly for seniors who already have a higher risk of falls due to balance problems, side effects of certain medications, or other high risks.

It’s important to implement a fall-prevention protocol, which involves actions such as removing electrical cords or rugs that could increase the risk of accidental tripping.

People with AMD should be particularly cautious of falling in an environment with low light. An environment that is not very well lit makes it more difficult to see objects that could be obstructing one’s path, particularly for those with AMD.

When to See a Doctor

When a person has dry AMD, it’s important to perform self-checks frequently to screen for the possibility of progression to wet AMD, which can develop very rapidly.

Regular at-home checks should include covering one eye at a time to check for any changes in vision that are noticed (such as a difference in the perception of the shape or color of objects).

Another way to check your own vision is to look at reading material or some sort of graph (such as the Amsler grid) every day to see if you notice any changes. The changes may include blurriness or wavy or missing lines or letters.

The grid should be viewed with reading glasses on. If the lines on the grid appear wavy or if an area of the lines is missing, contact your opthalmologist.

You can download and print a copy of the Amsler grid from the American Macular Degeneration Foundation. If you notice any changes in your vision, it’s imperative to consult with your ophthalmologist or another healthcare provider as soon as possible.

A Word From Verywell

When it comes to wet AMD, the most important thing to keep in mind is that symptoms can progress very quickly. Early diagnosis and intervention are vital to being able to slow down the progression of the disease.

That’s the reason daily self-checks and regular eye doctor appointments are so important. Keep in mind that many people with AMD have learned to live with the disorder and continue to report a high quality of life.

Staying on top of self-screening for new symptoms, seeing an ophthalmologist when necessary, and seeking professional help for any new symptoms or complications (such as depression) are vital steps in the overall long-term treatment plan for those with age-related macular degeneration.