How Wet Macular Degeneration Is Treated

Age-related macular degeneration (AMD) is the leading cause of vision loss in people over 60. The disease affects a portion of the retina of the eye called the macula that is responsible for central vision. Of the two types of AMD—dry and wet—wet AMD is the more severe and requires more aggressive treatment.

While the treatment or dry AMD consists of lifestyle changes and nutritional support, the treatment of wet AMD focuses on stopping fluid leakage caused by neovascularization (the formation of abnormal blood vessels at the back of the eye). This may involve medications, specialist-driven procedures, or a combination of the two.

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Laser surgery for vision correction

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Although wet AMD can be treated, there is no cure; current therapies only slow the progression of the disease. With that said, early treatment can help ensure that you retain your vision for longer.

Prescriptions

There is a class of drugs called anti-vascular endothelial growth factor (anti-VEGF) that are injected directly into the eye to prevent neovascularization. It does so by blocking the action of a protein called vascular endothelial growth factor (VEGF) that stimulates the formation of blood vessels.

What Is VEGF?

VEGF's normal function is the promote the formation of new blood vessels after an injury, However, if the trauma is ongoing, the excessive production of VEGF can cause the abnormal formation of blood vessels. With wet AMD, this can lead to retinal bleeding, retinal scarring, and vision loss.


Anti-VEGF drugs are delivered by intravitreal injection (into the clear, jelly-like substance inside the eye) after the eye has been numbed. The shots are relatively painless.

The frequency of injections varies by the drug type, five of which are currently approved by the Food and Drug Administration (FDA):

  • Lucentis (ranibizumab): Injected once monthly
  • Avastin (bevacizumab): Injected once monthly (and used off-label for the treatment of wet AMD)
  • Macugen (pegaptanib): Injected every six weeks
  • Eylea (aflibercept): Injected once monthly for the first four shots and then every other month thereafter
  • Beovu (brolucizumab): Injected once monthly of the first three shots and then every two to three months thereafter

Side effects are similar for all five drugs and include eye pain, eye inflammation, floaters, cataracts, conjunctival bleeding, and other changes in vision.

Other anti-VEGF drugs are under active research and development.

Surgeries and Specialist-Driven Procedures

In addition to anti-VEGF medications, there are procedures that can help slow disease progression. Surgery is less commonly used but may be considered if both eyes are affected and anti-VEGF drugs prove insufficient.

Laser Photocoagulation

Laser photocoagulation is a procedure sometimes used to treat wet AMD that helps seal leaks and destroy abnormal blood vessels. The procedure is normally performed in the healthcare provider's office and involves the dilation the eyes and anesthetic drops to help numb them.

The risks of laser photocoagulation are significant and may include:

  • Mild vision loss
  • Reduced night vision
  • Reduced peripheral (side) vision
  • Blind spots
  • Focusing problems
  • Blurry vision
  • Reduced color vision

Laser photocoagulation is not for everyone. It is less helpful if you have scattered blood vessels or the vessels are situated in the central part of the macula.

Photodynamic Therapy

Photodynamic therapy is another form of laser therapy that uses a special photosensitizing drug called verteporfin.

Prior to the procedure, verteporfin is injected into a vein, which eventually migrates to the blood vessels in the macula. After the eye is numbed, a laser beam is directed at the vessels through special contact lenses. The light activates the drug, triggering the formation of blood clots and sealing off the vessel.

Risks associated with photodynamic therapy include:

  • Blind spots
  • Back pain (related to the medication)
  • Temporary loss of visual sharpness

Photodynamic therapy tends to work best for people whose vision loss is gradual rather than for those who are experiencing the rapid deterioration of their vision.

Low Vision Rehabilitation

AMD doesn't affect your peripheral vision and usually doesn't cause total blindness. What it does affect is your central vision, which you need for driving, reading, and recognizing people and objects.

Low vision rehabilitation is a team-based strategy used to compensate for reduced vision in order to maintain independence and improve the quality of life. The team may involve a certified low vision rehabilitation specialist along with an ophthalmologist, occupational therapist, teacher of the visually impaired, psychologist, social worker, and other allied health professionals.

The rehabilitation plan may include assistive technologies like optical or electronic magnification devices, contrast filters, text-to-speech software, and screen readers.

Surgery

Surgery may be considered for people with severe vision loss who have shown no improvement despite the recommended treatments. This is especially true if both eyes are affected. Even so, the surgeries involve significant risks and are generally considered a last resort.

Options include:

  • Submacular surgery: This surgery is used to remove abnormal blood vessels and treat the associated bleeding. The surgery carries certain risks, including the risk of retinal detachment and the progression of cataracts.
  • Macular translocation surgery: This surgery involved the detachment and relocation of the retina (along with the macula) to a less-damaged area. Risks include retinal detachment and double vision.
  • Pneumatic displacement of subretinal hemorrhage: This procedure uses pressurized air or gas to create a bubble in the vitreal fluid of the eye. Doing so quickly disperses any bleeding at the back of the eye and provides a short-term improvement in vision.
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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Ricci F, Bandello F, Navarra P, Staurenghi G, Stumpp M, Zarbin M. Neovascular age-related macular degeneration: therapeutic management and new-upcoming approaches. Int J Mol Sci. 2020 Nov;21(21):8242. doi: 10.3390/ijms21218242

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  8. American Academy of Ophthalmology. Low vision rehabilitation teams and services.