Wet Macular Degeneration
What is wet macular degeneration?
Wet macular degeneration is a form of age-related macular degeneration (AMD). AMD is a progressive eye disease that affects up to 11 million Americans. It’s also one of the most common causes of vision loss in people 60 years of age and older. AMD is a disease that affects the retina—the light-sensing cells lining the back of the eye. The macula is the center of the retina that lets you see things sharply in front of you.
There are two types of AMD—dry and wet. In wet macular degeneration vs. dry, dry AMD is the most common form. It accounts for about 80 to 90% of cases. Wet AMD is less common, but more severe than the dry type. It causes 90% of severe vision loss in people with AMD. Everyone who gets wet AMD had dry AMD at one point. This is true even if they didn’t notice any symptoms until wet AMD was diagnosed.
In dry AMD, deposits of oxidative waste products and protein—called drusen—collect underneath the macula. This causes it, and your central vision, to slowly deteriorate. Wet AMD happens when new, abnormal blood vessels grow under the retina. Unlike healthy blood vessels, these abnormal vessels tend to bleed or leak fluid. This causes fluid accumulation within the macula, which rapidly and severely distorts central vision. The leakage of fluid is called exudate. So, another name for wet AMD is exudative AMD.
First-line wet macular degeneration treatment involves painlessly injecting biologic medications into the eye. The injections stop new blood vessels from forming and cause abnormal vessels to regress. Other options include laser therapy to destroy the abnormal blood vessels.
Left untreated, wet AMD progresses quickly and can lead to complete central vision loss. Seek prompt medical care if you notice changes in your central vision. If you have dry AMD, contact your doctor right away if you notice changes in your at-home vision testing.
What are the symptoms of wet macular degeneration?
Wet macular degeneration symptoms are generally more severe than in dry AMD. The exudates cause dark or blank spots in central vision. Lines appear wavy or crooked instead of straight due to macular bulging. Color and brightness can also suffer. However, peripheral vision remains clear.
The progression to wet AMD can happen quickly. Symptoms often start suddenly and can worsen in a short time. It is possible to have wet AMD in one eye and dry AMD in the other. So, symptoms can vary between the eyes.
Common wet macular degeneration symptoms include:
- Blank or dark spots in the central vision
- Complete central vision loss
- Dampened color vision or colors looking different in each eye
- Distorted vision, such as straight lines appearing bent, crooked or wavy
- Objects having distorted shapes or appear to be different sizes in each eye
The symptoms of wet AMD can make it difficult to recognize people’s faces, watch TV, read, perform daily activities, and safely move around by yourself. If you have dry AMD, your doctor will give you tools for monitoring your vision for any changes. Contact your doctor promptly if you notice any changes in one or both eyes.
What causes wet macular degeneration?
The reason either dry or wet AMD develops is unclear, but the risk increases with age. Genes seem to play a role in developing AMD and in the progression of the disease. Other factors that can worsen AMD include smoking and obesity. Once wet AMD develops in one eye, certain factors increase the risk of developing it in the other.
Everyone who develops wet AMD started out having dry AMD. Wet AMD occurs when new blood vessels begin growing under the macula. These vessels aren’t normal and can leak blood and fluid. When this happens, the fluid collects under the macula and can lift it up or cause it to bulge. This distortion leads to the symptoms of wet AMD.
What are the risk factors for wet macular degeneration?
Wet AMD develops from dry AMD, even if you never notice any symptoms of dry AMD. Doctors can use certain markers to gauge the risk of progression from dry to wet AMD. These markers include:
- Larger drusen—the protein deposits underneath the macula
- More than five drusen
- Pigment clumping—discrete areas of hyperpigmentation
- Uncontrolled high blood pressure
Reducing your risk of wet macular degeneration
If you have dry AMD, there are steps you can take that may lower your risk of progressing to wet AMD. This includes:
- Eating a diet rich in antioxidants by including plenty of fresh fruits and vegetables
- Effectively treating other medical conditions, such as high blood pressure and heart disease
- Including omega-3 fatty acids in your diet by eating fish and nuts
- Maintaining a healthy weight
- Stopping smoking
- Taking an AMD dietary supplement as recommended by your doctor, which can reduce the risk of progression by 25%
In addition, it’s important to monitor your vision at home. It can improve the detection of wet AMD when it first develops. This is key because early intervention can save your vision. Self-monitoring options include:
- Amsler grid, which looks like graph paper. The intersecting lines will appear wavy or smudged if AMD is worsening.
- ForeSeeHome Monitor, which is an FDA-approved device. With daily use, it is up to 94% effective and can detect changes before patients notice them. Medicare will cover the device for people who meet criteria for being at high risk of progression to wet AMD.
Contact your doctor as soon as possible if these tests show changes in your vision.
How is wet macular degeneration diagnosed?
Home monitoring is one of the most important tools in diagnosing wet AMD when you know you have dry AMD. Other tests your doctor may use include:
- Dilated eye exam to look at the retina
- Fluorescein angiography, which involves injecting a dye in a vein that will travel to the eye and highlight blood vessels and identify abnormal or leaky ones
- Indocyanine green angiography, which is similar to fluorescein angiography but can identify abnormal blood vessels deeper in the retina
- Optical coherence tomography (OCT), which is a noninvasive imaging exam that looks at cross-sections of the retina. A newer version, OCT angiography, is available at some specialty clinics.
How is wet macular degeneration treated?
The goals of wet AMD treatment are to slow progression, preserve existing vision, and reverse vision loss if possible. In the past, laser treatment was the only way to seal leaky blood vessels and treat wet AMD. However, there were limitations to laser therapy. Not all lesions were eligible for laser treatment, up to half of people continued to have some leakage, and there was a 50% chance of recurrence within two years. These treatments include photocoagulation and photodynamic therapy.
Today, anti-VEGF medications are the most effective and most common treatment for wet AMD. VEGF stands for vascular endothelial growth factor. Doctors painlessly inject the drug into the eye every 4 to 6 weeks. They work by inhibiting the growth of new blood vessels and causing existing abnormal vessels to recede.
Anti-VEGF drugs for wet AMD include:
- Aflibercept (Eylea)
- Bevacizumab (Avastin)
- Brolucizumab (Beovu)
- Ranibizumab (Lucentis)
Low vision rehabilitation can also be an effective part of a wet AMD treatment plan. It can teach you how to make the most of the vision you have and manage vision loss. Several devices and technologies can assist you in maintaining your independence. Ask your doctor about working with a low vision rehabilitation specialist or occupational therapist.
What are the potential complications of wet macular degeneration?
With newer anti-VEGF treatments, the wet macular degeneration prognosis has improved for most people. Some people are even able to regain some of their vision using these drugs. However, if wet AMD progresses to central vision loss, complications are possible including:
- Charles Bonnet syndrome, which occurs when people experience visual hallucinations as a result of the brain adjusting to partial or complete vision loss
- Social isolation and depression
Finding support through a community or online group or with a counselor can help people sort through various emotions surrounding wet AMD and vision loss.