How Wet Age-Related Macular Degeneration (AMD) Is Treated

Wet age-related macular degeneration (AMD) can be treated with medications, surgery, or a combination of therapies. Wet AMD cannot be cured, but these treatments may help slow the disease's progression.

Wet AMD is the more advanced of the two forms of AMD. (The other is "dry" AMD.) Early and aggressive treatment of wet AMD is needed to prevent vision loss that can occur when abnormal, fragile blood vessels form and leak on the thin tissue at the back of the eye (retina).

This article will go over the treatment options for Wet AMD, including the benefits and limitations of each type.

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What to Know Before You Start Wet AMD Treatment

If you have wet AMD, it's important to understand how the condition works and what treatment can and cannot do.

Wet AMD affects the retina, the part of the eye that takes in visual information and sends it to the brain. Wet AMD affects the part of the retina responsible for central vision (macula) as well as your ability to see colors and fine details. Even though dry AMD is more common, wet AMD is responsible for 90% of cases of legal blindness.

AMD is the leading cause of vision loss in people over the age of 60. AMD does not affect your side (peripheral) vision and usually does not cause total blindness. AMD affects your central vision, which you need for driving, reading, and recognizing people and objects.

Dry AMD progresses slowly and can usually be managed with lifestyle changes. Wet AMD requires medical treatment to prevent vision loss in one or both eyes.

You can help preserve your vision by seeking medical care if your vision loss is happening fast or affecting your functioning or quality of life. Getting diagnosed and starting treatment as soon as possible is essential to protecting your sight if you have wet AMD.

However, you should know that treatment for wet AMD is unlikely to restore your vision completely, and may not help at all. Some people do get some of their vision back, but it is usually not as good as it was before they were diagnosed with wet AMD.

Do not let this discourage you from getting treated if you're diagnosed with wet AMD. Just keep this information in mind and adjust your expectations before you start treatment.

Prescription Medications

Anti-vascular endothelial growth factors (anti-VEGF) are a group of drugs that are injected directly into the eye to prevent the formation of abnormal blood vessels (neovascularization).

The drugs work by blocking the action of a protein called vascular endothelial growth factor (VEGF) that stimulates the formation of blood vessels.

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

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

The frequency of injections varies depending on the specific drug, seven of which are currently approved by the Food and Drug Administration (FDA):

• Lucentis (ranibizumab): Injected once monthly
  
• Avastin (bevacizumab): Injected once monthly (this drug is 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 for the first three shots and then every two to three months thereafter
• Vabysmo (faricimab-svoa): Injected once every four weeks to start, then continued on a new regimen based on results of vision tests
• Susvimo (ranibizumab implant): Continuously given through an implant that needs to be refilled about every six months

The side effects are similar for all the medications used to treat wet AMD and include:

• Eye pain
• Eye inflammation
• Dark spots that seem to float across the eye (floaters)
• Clouding of the lens of the eye (cataracts)
• Conjunctival bleeding
• Changes in vision

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

Surgeries and Specialist-Driven Procedures

Surgery is less commonly used to treat wet AMD but might be considered if both eyes are affected and anti-VEGF drugs have not helped. There are a couple of procedures that may help slow the progression of wet AMD.

Laser Photocoagulation

Laser photocoagulation is a procedure that is sometimes used to treat wet AMD. It works by sealing leaks and destroying abnormal blood vessels.

The procedure is done in a healthcare provider's office. After dilating the pupils with tropicamide eyedrops, the provider aims a laser at the part of the retina being treated and destroys abnormal blood vessels using pulses of intense light.

Laser photocoagulation may involve a few pulses or as many as 500. Anesthetic eye drops may or may not be needed.

The risks of laser photocoagulation are significant and include:

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

Photodynamic Therapy

Photodynamic therapy is another form of laser therapy for wet AMD. It uses a special drug called verteporfin that makes your eyes more sensitive to light.

Before the procedure, verteporfin is injected into a vein and moves 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.

This procedure is not used as often as other treatments for wet AMD because the results tend to be short-term. People whose vision loss is progressing slowly are better candidates for photodynamic therapy. When used, it is often done in combination with prescription medications.

Risks associated with photodynamic therapy include:

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

Low Vision Rehabilitation

Low vision rehabilitation is a team-based strategy for treating wet AMD. It helps people learn to compensate for reduced vision so they can maintain independence and improve their quality of life.

The team members can include a certified low-vision rehabilitation specialist, an ophthalmologist, an occupational therapist, a teacher of the visually impaired, a psychologist, a 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 for wet AMD is sometimes considered for people with severe vision loss who have shown no improvement after trying the recommended treatments. Surgery is more likely to be considered if both of a person's eyes are affected.

Surgery for wet AMD comes with significant risks and is generally considered a last resort.

Surgeries for wet AMD include:

• Submacular surgery: This surgery removes the abnormal blood vessels and treats any bleeding associated with them. The procedure carries risks, including retinal detachment and the progression of cataracts.
• Macular translocation surgery: This surgery involves the detachment and relocation of the retina to a less-damaged area. Risks of the procedure include retinal detachment and double vision.
• Pneumatic displacement of subretinal hemorrhage: This procedure uses pressurized air or gas to create a bubble in the eye fluid. Doing this quickly disperses any bleeding at the back of the eye and provides a short-term improvement in vision.

Summary

Wet age-related macular degeneration (AMD) is a more advanced form of macular degeneration. It occurs when abnormal blood vessels form and leak on the retina of the eye. Wet AMD is typically treated with a class of drugs called anti-VEGF agents that prevent the formation of abnormal blood vessels. The drugs are given by injection directly into the affected eye.

In addition to anti-VEGF drugs, specialist procedures like laser photocoagulation and photodynamic therapy are sometimes recommended to slow the disease progression. Low-light rehabilitation is a form of therapy that can teach you to better cope as vision loss occurs. Surgery is usually only done if both eyes are affected and other treatments have not worked.

Although treatments can help preserve your vision, they are unlikely to restore your vision to what it was before you were diagnosed with wet AMD.

A Word From Verywell

The cost of treatment can be prohibitive for people living on a fixed retirement income. Fortunately, there are patient assistance programs designed specifically to assist with the cost of AMD treatment.

Ask your healthcare provider for a referral to a social worker who can help you access financial aid or contact the American Society for Retina Specialists at (312) 578-8760 for referrals to manufacturer and independent patient assistance programs for people with AMD.