How Wet Macular Degeneration Is Treated

Wet AMD is the more advanced of the two forms of age-related macular degeneration (AMD). Aggressive treatment of wet AMD is needed to help prevent extensive vision loss that can occur when abnormal (and fragile) blood vessels form and leak on part of the retina, the thin tissue at the back of the eye.

Wet AMD cannot be cured. However, medications, specialist procedures, or a combination of the two may help slow the disease's progression.

This photo contains content that some people may find graphic or disturbing.

Laser surgery for vision correction

sdigital / Getty Images

This article explores the various treatment options for wet AMD, including their benefits and limitations.

Importance and Realities of Wet AMD Treatment

Before exploring wet AMD treatment options, it's important to be aware of what they can and cannot do.

AMD is the leading cause of vision loss in people over 60. It 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.

Wet AMD is responsible for 90% of cases of legal blindness, even though the dry form of the disease is far more common.

Dry AMD is slower-progressing and can be managed with lifestyle and nutrition, but wet AMD requires medical intervention to prevent the loss of vision in one or both eyes.

You can help preserve your vision by starting wet AMD treatment immediately and seeking appropriate care if your vision loss is rapid or affecting your functioning or quality of life.

Still, wet AMD treatments are unlikely to restore your vision significantly. In some cases, they may not help at all. Some people may start to get some of their vision back, but it is usually not to the level they have before developing wet AMD.

This certainly should not discourage you from getting treated. Managing your expectations with this in mind, however, will help you be better prepared for the road ahead.

What Parts of the Eye Does Wet AMD Affect?

Wet AMD affects the retina, which receives visual information and sends it to the brain. More specifically, it impacts the macula, part of the retina responsible for central vision as well as your ability to see colors and fine details.

Prescriptions

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, or neovascularization. They do so 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 to promote 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. 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 depending on the drug, 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, or not as formally indicated, 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 (dark spots that seem to pass across the eye), cataracts (clouding of the lens), 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. It works by helping seal leaks and destroying abnormal blood vessels.

The procedure is performed in a healthcare provider's office. After dilating the pupils with tropicamide eyedrops, the healthcare provider aims a laser at the part of the retina being treated and destroys abnormal blood vessels with pulses of intense light. Laser photocoagulation may involve a few pulses or as many as 500. Anesthetic eyedrops may or may not be needed.

The risks of laser photocoagulation are significant and may include:

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 drug called verteporfin, which makes your eyes more sensitive to light.

Prior to the procedure, verteporfin is injected into a vein. It 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.

While an option worth mentioning, it is not used as often as other treatments for wet AMD because the results are generally short-term. People whose vision loss is progressing slowly rather than rapidly are better candidates for photodynamic therapy. When it is used, it is often done in tandem with prescription drug use.

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 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 associated bleeding. The procedure carries certain risks, including that of 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 include retinal detachment and double vision.
  • Pneumatic displacement of subretinal hemorrhage: This procedure uses pressurized air or gas to create a bubble in eye fluid. Doing so quickly disperses any bleeding at the back of the eye and provides a short-term improvement in vision.

Clinical Trials

Research into treatments for wet AMD is ongoing. If you are interested in participating in a study, you can look for open clinical trials by searching the National Institutes of Health Clinical Trials database, or ask your healthcare provider.

Summary

Wet aging-related macular degeneration (AMD) is a more advanced form of macular degeneration in which abnormal blood vessels begin to 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 may be 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 generally only pursued if both eyes are affected.

Although treatments like these 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 those 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.

Was this page helpful?
9 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.
  1. BrightFocus Foundation. Age-Related Macular Degeneration Facts & Figures.

  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

  3. Hobbs SD, Pierce K. Wet age-related macular degeneration (wet AMD). In: StatPearls [Internet].

  4. Genentech. Package insert - Lucentis (ranibizumab injection) intravitreal injection.

  5. Genentech. Package insert - Avastin (bevacizumab).

  6. Gilead Sciences. Package insert - Macugen (pegaptanib sodium injection) intravitreal injection.

  7. Regeneron Pharmaceuticals. Package insert Eylea (aflibercept), for intravitreal injection.

  8. Novartis Pharmaceuticals. Package insert - Beovu (brolucizumab-dbll) injection, for intravitreal injection.

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