How Wet Macular Degeneration Is Treated

Age-related macular degeneration (AMD) is the leading cause of vision loss in people over the age of 60. AMD affects the macula, the sensitive part of the retina responsible for our sharp, central vision. Although AMD can be treated, there is no cure. There are two types of AMD: dry and wet. Wet AMD, the more severe of the two, accounts for approximately 10% of all AMD cases. People with the dry form of AMD may progress to the wet form, but dry macular degeneration may also advance and cause vision loss with or without turning into the wet type of the disease.

However, not everyone with early AMD will develop the advanced form of the disease. While treatment for dry AMD consists of nutritional therapy with a healthy diet high in antioxidants to support the cells of the macula, treatment for wet AMD focuses on stopping the fluid leakage from neovascularization.

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Laser surgery for vision correction

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Treatment Options

No cure exists for wet AMD. However, several treatment options are available to slow the progression of the disease, and hopefully slow the rate of vision loss. These treatments won’t reverse the course of macular degeneration, nor will they completely stop it, but they can help slow the disease progression and help to preserve existing vision. Procedures such as photocoagulation and macular translocation have been performed with variable results. Anti-vascular endothelial growth factor (anti-VEGF) medications are also being used. These medications are injected directly into the eye and act to stop new blood vessels from forming.

Following are the best treatment options available for wet AMD.

Prescription Injections: Anti-VEGF Drugs

The term "angiogenesis" is used to describe the growth of new blood vessels. Angiogenesis plays a critical role in the normal development of body organs and tissue. However, excessive and abnormal blood vessel development can sometimes occur in diseases such as AMD (retinal bleeding) and cancer (tumor growth). Anti-angiogenic drugs are used to stop the growth of new blood vessels. These drugs are often referred to as anti-VEGF treatments, as they are focused on reducing the level of a growth protein known as vascular endothelial growth factor (VEGF).

Anti-VEGF treatments aim to reverse the blood vessel growth process and improve vision. The following medications are intravitreal injections (injected directly into the numbed eye) utilized as first-line treatment to reduce macular swelling and potentially improve vision.

  • Macugen (pegaptnib) - Macugen is injected into the vitreous portion of the eye, usually once every six weeks. Side effects may include inflammation of the eye, blurred vision, other changes in vision, cataracts, bleeding, swelling, eye discharge, irritation or discomfort of the eye, and seeing spots in vision. In general, Macugen reduces macular thickness but does not improve visual acuity.
  • Avastin (bevacizumab) - Avastin is injected into the vitreous portion of the eye. It is an FDA-approved cancer therapy drug made by the same company that makes Lucentis. Avastin has been used by doctors as an off-label treatment for AMD and is much less expensive. Many doctors believe the two drugs are equally effective against macular degeneration. Avastin is usually administered once per month.
  • Lucentis (ranibizumab) - Lucentis is injected into the vitreous portion of the numbed eye, usually once per month. The most commonly reported side effects of Lucentis include hemorrhage of the conjunctiva, floaters, eye pain, increased eye pressure, and inflammation of the eye.
  • Eylea (aflibercept) - Eylea is injected into the eye once every other month. Side effects may include hemorrhage of the conjunctiva (the membrane that covers the white of the eye), eye pain, risk of cataract, vitreous detachment, vitreous floaters, and increased eye pressure.

Be aware that there is a risk for endophthalmitis (severe inflammation of the eye interior) and retinal detachment following any injection into the vitreous.

Surgeries and Specialist-Driven Procedures

Laser Photocoagulation

Laser photocoagulation is a type of laser surgery sometimes used to treat wet AMD. This treatment is not an option for everyone who has wet type AMD, as the procedure is less helpful if you have scattered vessels or if the vessels are in the central part of the macula.

Using small bursts of light, the laser attempts to seal leaky blood vessels and destroy abnormal blood vessels and tissues. The surgery is normally performed in-office and can take up to 30 minutes. Your doctor will first dilate your eyes, and may numb your eyes with an anesthetic eye drop. In most cases, neither a patch or post-surgery medication is required.

The following risks are associated with laser photocoagulation, due to the intensity of the beam of light:

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

Photodynamic Therapy

Photodynamic therapy is another type of treatment for wet AMD that uses a laser. It differs from photocoagulation in that it uses a special medicine that works when exposed to a certain type of light. Before the procedure, the doctor will inject a special medicine into a vein in your arm. The medicine is sensitive to light, and collects in the abnormal blood vessels underneath the macula. After instilling an anesthetic eye drop, the doctor will shine a laser into your eye with the help of a special contact lens. The laser light activates the medicine which then seals off the abnormal blood vessels by creating blood clots. Photodynamic therapy is not an option for everyone with wet AMD. It may be most helpful for people whose vision loss comes on slowly over time, instead of suddenly.

The following risks are associated with photodynamic therapy:

  • Blind spots
  • Back pain related to medicine injection
  • Photosensitivity reactions
  • Temporary loss of visual sharpness
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Article Sources
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