An Overview of Wet Macular Degeneration

In This Article

Worldwide, age-related macular degeneration (AMD) is the leading cause of severe vision loss in people aged 50 or older. Neovascular AMD is an advanced form of the condition, also known as “exudative AMD" or “wet macular degeneration.” The wet form is less common than the dry form of AMD, occurring in roughly 10–15% of people who have AMD. The risk of AMD increases significantly in people over the age of 80.

Symptoms

Typically wet AMD results in severe vision loss. These symptoms may come on suddenly and worsen quickly, even though the underlying problem has been developing over a long period of time. Wet AMD might affect only one of your eyes or both.

Wet AMD affects the central part of your visual field, not the peripheral areas. Because of this, only rarely does it cause total blindness. The central area of your visual field might have a blind spot, or this area might become very blurry. Some other specific symptoms might include:

  • Decreased color brightness
  • Visual distortions (e.g., a straight object appearing to bend)
  • General haziness of vision

Dry and wet AMD typically affect both eyes, though you may first lose vision in just one. People with wet AMD can also suffer from problems resulting from these vision issues. For example, people might become depressed and socially withdrawn because they are having trouble with tasks they once performed easily. Not surprisingly, it can profoundly affect people’s quality of life.

Causes

To understand what causes wet AMD, it’s helpful to understand a little about your eye. A part of the retina, your macula is located at the back part of your eye and helps provide the sharp vision that you have in the center of your visual field when looking straight ahead.

The macula has many light-sensing cells that send electrical signals via the optic nerve to the brain, which puts together the images that we see. That’s why damage to the macula can cause that central part of your visual field to appear blurry and dark.

The layer of the eye just behind the retina is called the choroid. It normally has blood vessels that bring blood to the light-cells of the retina (and macula). But in wet AMD, blood vessels from the choroid can start to invade the retina and grow abnormally there. These fragile vessels may start to leak, which can interfere with the normal function of the macula. That’s why this type of AMD is called “wet” AMD.

The abnormal blood vessel growth found in wet AMD is partially caused by the presence of a signaling molecule called VEGF (vascular endothelial growth factor). This may be found at higher than normal levels in people with wet AMD.

Environmental and Genetic Factors

AMD (and wet AMD specifically) are probably caused by a combination of environmental and genetic factors that are still not completely understood. Some of the factors thought to increase one’s risk of getting AMD are:

  • History of smoking
  • Family history of AMD
  • Previous cataract surgery
  • Cardiovascular risk factors (such as known atherosclerosis, high cholesterol, or high blood pressure)
  • White racial background

Types

Wet macular degeneration is a specific subtype of age-related macular degeneration. In the dry version of AMD, there aren’t the same kinds of abnormal blood vessels beneath the eye. However, there may be other problems causing more gradual damage to the light-sensing cells of the macula.

People with AMD also have something called drusen, which are yellow deposits found beneath the retina. Though drusen are a normal part of aging, large or medium drusen are often a sign of AMD.

Dry AMD might be early, intermediate, or advanced. People with early or intermediate disease might not notice any symptoms. In contrast, the wet form of AMD is always an advanced form of the disease.

Wet AMD always starts out as the dry version of AMD. That’s one of the reasons it’s important to monitor early forms of AMD for progression to later kinds.

Diagnosis

To diagnose wet AMD, your clinician will need to ask you about your symptoms and your medical history. This will include information about the exact nature and timing of your symptoms, your family medical history, and your other medical conditions.

You will also need a comprehensive eye exam, one in which your eyes are dilated with drops. Using information from your exam and clinical history, your clinician will diagnose wet AMD and rule out other major kinds of severe vision problems in older adults, like eye complications from diabetes, glaucoma, and cataracts.

Portions of the eye exam might include the following:

  • Basic tests of visual acuity
  • Examination of the back of your eye
  • Examination using an Amsler grid (pattern of gridded lines that may appear missing or distorted in someone with AMD)

If you have early or intermediate AMD, your physician might give you an Amsler grid to take home, so you can notice early signs that your vision might be worsening.

Other Eye Tests

If your doctor is worried that you might have wet AMD, you will probably need more advanced tests to confirm the diagnosis. These tests may also be used to see how you have responded to treatment.

In a fluorescein angiogram, a fluorescent dye is injected into your arm by an ophthalmologist. Pictures can be taken as the dye passes through the blood vessels of the eye, showing the leaky abnormal blood vessels of wet AMD. This can not only diagnosis wet AMD but also provide detailed information about the specific anatomical characteristics of your eyes. Sometimes that's relevant for treatment choices.

Another option for diagnostic confirmation is optical coherence tomography. This painless and non-invasive test uses light waves to get an image of the back of the eye. Depending on the situation, additional tests may be options as well.

It’s important to seek medical attention and get a proper diagnosis as soon as possible after your symptoms start. If your diagnosis and treatment are delayed, it may become difficult—or impossible—to reverse your symptoms.

Treatment

In recent years, treatments have become available that may help slow vision loss from wet AMD. However, it’s important to realize that in some cases the disease may worsen even when you receive proper treatment.

Injections of VEGF drugs

Currently, a group of drugs known as anti-VEGF agents are the first treatment used for wet AMD. Since they were approved in 2006, they have revolutionized the treatment for wet AMD. Now, far fewer people are becoming legally blind due to the condition than in the past.

Researchers targeted VEGF because of the role it plays in the formation of new blood vessels. They developed the “anti-VEGF drugs,” which block the signaling of this molecule. This helps prevent the growth of more abnormal blood vessels. In some cases, the injections help the person to at least partly improve their vision.

These drugs are injected into the eye itself, sometimes multiple times in a month, after your eye is numbed and cleaned with an antiseptic drop. After injections, you may need to take antibiotic eye drops and injections may be less frequent after the initial treatment.

Some of the anti-VEGF drugs prescribed for wet AMD include:

  • Macugen (pegaptanib)
  • Lucentis (ranibizumab)
  • Avastin (bevacizumab)
  • Eylea (aflibercept)

Anti-VEGF drugs vary in their cost and in the frequency of needed injections, so it’s worth discussing your options with your healthcare provider.

Photodynamic Therapy and Laser Photocoagulation Surgery

Your doctor may suggest these options if you are still having issues after trying anti-VEGF therapies. They also may be an option if you have wet AMD with particular anatomical characteristics. They are sometimes used along with anti-VEGF drugs.

In photodynamic therapy, you are injected with a drug called verteporfin. The clinician activates the drug as it travels through the abnormal vessels by shining a laser beam into your eye. This activates the drug to close off these new blood vessels. This potentially slows vision loss.

Laser photocoagulation surgery is a less common option. It's a type of minimally invasive surgery for the eyes that can be used to seal or destroy the leaky blood vessels.

Nutritional Supplements

Some evidence shows that certain nutritional supplements may help slow vision loss in people that have wet AMD (though it will not restore vision that's already lost). It also might help prevent the development of wet AMD in your other eye.

In clinical trials, the combination of nutrients and antioxidants found to be helpful were:

  • Vitamin C (500 milligrams)
  • Vitamin E (400 International units)
  • Zinc (80 milligrams zinc oxide)
  • Copper (2 milligrams cupric oxide)
  • Lutein (10 milligrams)
  • Zeaxanthin (2 milligrams)

You might benefit from taking additional supplements, even if you already take a multivitamin, because not all multivitamins will contain all these nutrients. Talk to your physician about the best product for you to take.

Lifestyle Modifications

Practicing a healthy lifestyle is also an important part of treatment and prevention. By regularly exercising, eating a healthy diet, and not smoking, you may help slow the progression of your disease.

Coping

Some people find it very hard to cope with wet AMD, especially if treatment is unable to restore their vision loss. Understandably, it can be a real psychological and physical challenge to cope if you are having problems performing your everyday tasks. Many people report depression and reduced quality of life from these visual changes. You may need to go through a grief process before you can accept your life and move forward.

While it’s normal to feel these things, know that you have resources to support you. There are a number of professionals that can help you as you adjust to life with poorer vision. These may include occupational therapists, mobility specialists, and low vision therapists. Depending on the situation, social workers or counselors may be able to help as well. These professionals can provide a wide range of products, services, and education that can help you adapt to your new situation.

A Word From Verywell

It can be a shock to learn that you have a serious medical problem like wet age-related macular degeneration. Realistically, the condition is likely to disrupt your everyday life, at least for a while. Fortunately, there are now treatment options that may be able to help restore your vision and health professionals who can help you make the most of your situation. Learning what you can about your treatment options can help give you a sense of control. 

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Article Sources

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