Macular Degeneration (Wet form)

1. What is wet age-related macular degeneration?

Wet age-related macular degeneration (wet AMD) is a chronic eye disorder that causes blurred vision or a blind spot. It is so named because of the involvement of blood or fluid leakage into the macula (MAK-u-luh), which is the part of the retina that provides us the ability to read and see in fine detail.

Although wet AMD can occur spontaneously, it is usually preceded by dry AMD.

There are treatments available for Wet AMD. Early detection and timely treatment may help reduce vision loss or even recover vision. 

2. What are the symptoms of wet AMD?

You will probably be the first person to notice changes in vision due to wet AMD. The symptoms usually appear suddenly and may worsen rapidly.

Wet AMD affects people in different ways. They may include: 

• Straight lines such as road lines or door frames seem bent or distorted
• Difficulty recognizing faces 
• Objects may appear to change shape or size and words may become blurry or even disappear when reading
• Bright light may be more uncomfortable 
• Increased difficulty to adapt when moving between light and dark rooms
• Colors look faded
• Sudden blind or dark spots may appear in your vision

Since wet AMD does not affect the entire retina – just the macula, you may experience extremely poor center vision and not your side (peripheral) vision. And, it rarely causes total blindness.

The symptoms of age-related macular degeneration may look like other eye conditions. 

Make sure you see and discuss with an eye care professional if you think you may have wet AMD. 

3. What to do if you have symptoms of wet AMD?

You should see your eye doctor or optometrist if:

• You notice changes in your central vision or your field of vision that is straight ahead
• You have difficulty seeing colors and fine detail
• You have other symptoms of wet AMD (see the above section for more detail)
• These are the first signs of the condition, particularly if you are over the age of sixty.

Your eye doctor can do some tests to see whether or not you have wet AMD. And if suspected, most people are referred to an AMD specialist, such as a retinal specialist, who can make a definitive confirmation and treat the condition.

4. What is the cause of wet AMD?

The exact cause of wet AMD is not fully understood. However, until recently, we have learned that in wet AMD, cells at the back of the eye produce an excessive amount of vascular endothelial growth factor also known as VEGF. It is a growth hormone that normally plays an important role in wound healing and new blood vessel formation. 

This hormone is believed to cause abnormal growth of new blood vessels from the choroid, the vascular layer of the eye that provides oxygen and nourishment to the outer retina. These vessels may grow from your choroid into the macula, like weeds growing up through cracks in the pavement. Since they are fragile, they may leak blood and fluid into the macula.

Vision loss due to Wet AMD may develop in the following ways:

• Abnormal blood vessel growth. When abnormal new blood vessels grow into your macula. These abnormal and fragile blood vessels may break and consequently leak fluid or blood into the macula, damaging the retina cells responsible for vision.

• Fluid buildup in the back of the eye. When fluid leaks, it can accumulate between the retinal pigment epithelium, a thin cell layer, and the retina. This accumulation of fluid can cause a bump in the macula impacting your vision.

Wet AMD is also often referred to as neovascular AMD in the medical community or in scientific journals. “Neo” means new and “vascular” means “blood vessel”.

5. What are the risk factors for wet AMD?

Some factors that may increase your risk of wet AMD are if you:

• Are over 55. And, it becomes even more common for people over 75.
• Have a family history of AMD. If your parents or siblings have AMD, you have up to 3 times greater risk of developing wet AMD. 
• Have dry AMD. Wet AMD happens in people who’ve already had dry AMD, even if they didn’t know they had it.
• Are a woman. Wet AMD is more common in women than in men. 
• Are Caucasian. 
• Smoke. Smoking doubles your risk of developing wet AMD.  
• Have cardiovascular disease. Conditions that affect your heart and blood vessels may raise your risk of developing wet AMD 
• Have obesity. Research indicates obesity makes it more likely that early-stage AMD will progress to the more severe wet form of AMD.

6. How to prevent wet AMD?

If you are at a higher risk of developing wet AMD, you should pay extra attention and have routine eye exams to identify early signs of the condition. There are a number of things that can reduce the risk of developing wet AMD. 

• If you smoke, quit smoking. Smokers are two to four times more likely to develop macular degeneration than nonsmokers. 
• Manage other medical conditions. For example, if you have cardiovascular disease or high blood pressure, take your medication and follow your doctor's instructions for controlling the condition.
• Maintain a healthy weight and exercise regularly. If you need to lose weight, manage your calories and exercise regularly.
• Choose a diet rich in fruits and vegetables. Choose a healthy diet that is full of different fruits and vegetables – eat plenty of dark, leafy greens like spinach. They contain antioxidants and vitamins, which have been shown to reduce the risk of developing wet AMD.
• Include fish and nuts in your diet. Fish (such as salmon, tuna, and mackerel) and nuts (such as walnuts, almonds, and hazelnut) are high in Omega-3 fatty acids, which may protect your eyes as you age.
• Ask your doctor about vitamin and mineral supplements for AMD. People at high risk of developing late AMD may be able to lower their risk by taking specific combinations of antioxidant vitamins and minerals.

7. How is wet AMD diagnosed?

Your eye doctor can do some tests to see whether or not you have wet AMD. They will usually first talk to you about your health history, including any vision problems you have, and ask you about your family’s health history. Then your doctor will do a complete eye exam, which may include:

• Examination of the back of your eye. Your eye doctor will put drops in your eyes to dilate them and use a special instrument to examine the back of your eye. These may make your vision blurred and sensitive to light for a short time, consider taking someone with you.
• Test for defects in the center of your vision. During an eye exam, your eye doctor may use an Amsler Chart to test your vision. If you have macular degeneration, some of the straight lines in the chart will look faded, broken, or distorted.  
• Fluorescein angiography (FA). During this test, your doctor injects a colored dye into a vein in your arm. The dye travels to and highlights the blood vessels in your eye. A special camera takes pictures as the dye travels through the blood vessels. The dye may temporarily change the color of your urine, it is normal. 
• Indocyanine green angiography (ICG). Like fluorescein angiography, this test uses an injected dye. It may be used to confirm the findings of a fluorescein angiography or to identify abnormal blood vessels deeper in the retina.
• Optical coherence tomography (OCT). This is a non-invasive imaging test that shows detailed cross-sections of the retina. OCT scans can detect early signs of AMD. 

8. What to do if you are diagnosed of wet AMD?

When you are diagnosed initially, it can be a shock and you might not know what to do. Consider the following valuable tips.

• Understanding your condition
  • Talk to your eye doctor about how to take control and manage wet AMD. There could be valuable support resources to help you. 
  • You may be interested in speaking to other people who also have the condition. Ask your eye doctor about patient support groups or associations.
• Telling your loved ones and friends
  • It is common for people to feel uncertain or even worried about telling others. However, telling those close to you is often the first step in making sure you get the support you might need. 
  • Having wet AMD may impact you, your family, and your friend. You may need help with everyday tasks. They may also be affected emotionally. Learn and understand the condition together.
• Understanding your treatment
  • It is important you know what your treatment options are and how they work. 
  • People who actively seek out care information and adhere to their treatment tend to have better treatment results.
• Other tips
  • There are helpful low vision aids technology and settings on computers. Try them. You may find using some of these new tools can help you adjust if your vision has been affected.

9. What are the treatments for wet AMD?

People with wet AMD can lose much of their vision within weeks. Treatments are available to prevent vision loss from worsening. If started early, some of the lost vision could even be recovered.

The most common treatments used to treat wet AMD are anti-vascular endothelial growth factors (anti-VEGFs). 

VEGF is a substance in the body responsible for blood vessel development. In wet AMD, excessive VEGF is produced in the eye, leading to the growth of abnormal blood vessels.

An anti-VEGF block VEGF from working and stop the development of these blood vessels. 

A. Medications

There are several anti-VEGFs approved by the FDA for treating wet AMD. 

• Beovu, also known as brolucizumab 
• Eylea or aflibercept
• Lucentis or ranibizumab 
• Vabysmo or faricimab*

Another drug, Avastin or bevacizumab, is also used even though it is licensed to treat cancer. 

All the anti-VEGFs are given as an injection into the eye. They are given at a monthly interval in the beginning. Your eye doctor then will personalize your treatment depending on your situation and how well you are responding to the treatment. Treatment intervals may vary from one every month to every four months. 

Make sure to follow your eye doctor’s recommended follow-up schedule closely. Patients who do not receive sufficient treatment may gradually lose their vision. 

*Vabysmo is an angiopoietin-2 (Ang2) and VEGF-A bispecific antibody

B. Laser treatment

Occasionally some people may receive a laser treatment, which carries a greater possibility of risk and is usually only offered if the patient's condition is suitable.     

10. What can I do to help prevent the worsening of wet AMD?

After receiving a diagnosis of wet macular degeneration, you can follow the seven tips below that may help you manage your condition and prevent it from worsening. 

• Keep to your appointments. Follow your eye doctor's recommended follow-up visit schedule, especially your treatment visits.
• If you smoke, ask for help and quit. Smoking may decrease the effectiveness of your treatment. If you smoke, ask your doctor if there is a smoking cessation program near you.
• Manage other medical conditions. For example, if you have cardiovascular disease or high blood pressure, take your medication and follow your doctor's instructions.
• Maintain a healthy weight and exercise regularly. If you need to lose weight, manage your calories and exercise regularly.
• Choose a diet rich in fruits and vegetables. Make sure you have a healthy diet full of different fruits and vegetables – eat plenty of dark, leafy greens like spinach. They contain antioxidants and vitamins that are helpful to your eye health.
• Include fish and nuts in your diet. Fish (such as salmon, tuna, and mackerel) and nuts (such as walnuts, peanut, and hazelnut) are high in omega-3 fatty acids, which may protect your eyes.

Tell your loved ones. Many people with wet AMD may find it difficult to tell others and worry about their reactions. However, telling them is the first step in ensuring you get the support you may need

11. What is the AREDS2 supplement?

A lot of research has been done on whether vitamins or supplements could be beneficial or slow down the worsening AMD. Research suggested that certain combinations of supplements, an AREDS2 nutrient formula, could slow down the worsening of AMD but not wet AMD. Further, AREDS2 is only beneficial to specific groups. (Source: National Eye Institute)

• If you have intermediate AMD in one or both eyes, the AREDS2 supplement may be able to stop its progression into late AMD - the wet type. 
• If you have late AMD in only one eye, the AREDS2 supplement may slow down the progression of AMD in the other eye. 
• If you already have late AMD in both eyes, the AREDS2 supplement probably won’t help.

But, there is no evidence of benefit if you have late AMD in both eyes or for the eye with active wet AMD.

The AREDS2 nutrient formula:

• Vitamin C 500mg
• Vitamin E 400 IU
• Copper 2mg
• Lutein 10mg
• Zeaxanthin 2mg
• Zinc 80mg

Taking supplements may be helpful. There also are possible health risks. Ask your doctor if taking supplements is appropriate for you.

Adapted from MayoClinic.org. Accessed March 2022. 

Information on this site is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only.