Many individuals with wet macular degeneration (AMD) can stabilize or improve their vision with regular injections of a drug that blocks vascular endothelial growth factor (VEGF). This protein may stimulate abnormal blood vessel growth that leads to choroidal neovascularization – the hallmark of wet AMD.

Dry macular degeneration

Dry macular degeneration is the less aggressive version of macular degeneration and involves a gradual thinning of the macula that impairs central vision. Usually first discovered in one eye and progressing more slowly than wet form of degeneration; typically painless as well. Symptoms include blurry spots near center field of view; difficulty adapting to low light levels; distortion of geometric shapes. Treatment for dry macular degeneration includes high doses of zinc and antioxidants.

Causes of AMD remain unknown; however it is believed to be linked with deposits of fatty waste and minerals called “drusen”, which accumulate underneath the retina. Certain genetic changes and risk factors including age, race, smoking, obesity, cardiovascular disease and high blood pressure increase one’s chances of having AMD.

About 10% of those with macular degeneration have the wet form, in which abnormal, leaky blood vessels form beneath the retina near the macula and leak fluid or bleed, leading to distorting straight-ahead vision as well as rapid and severe loss of central vision.

Laser treatments may be an option in certain instances of wet macular degeneration to destroy abnormally leaking blood vessels and prevent further vision loss, although it is only likely in rare instances and cannot reverse any existing vision loss.

Lifestyle changes may help slow the progression of macular degeneration. Patients should maintain a healthy weight, give up smoking, take vitamin supplements and visit their ophthalmologist regularly for dilated eye exams – this allows the doctor to detect problems early and treat them before becoming noticeable; and can identify early stages of macular degeneration. Low-vision aids may also be beneficial in helping manage macular degeneration such as magnifying text or tape-recorded books/magazines/large print playing cards/scales or using video cameras/ video cameras/devices etc.

The “wet” form of macular degeneration

Macular degeneration with “wet” characteristics is distinguished by the growth of blood vessels under the retina (neovascularization). This condition causes abnormal fluid leakage and clotting that leads to permanent loss of central vision as well as visual distortions such as doors frames or windows appearing wavy or tilted in vision.

At least there’s hope: treatment can significantly slow the progression of macular degeneration. This may include diet rich in antioxidant vitamins, regular visits to an eye doctor and using low vision aids like magnifying lenses. Other drugs available to reduce growth of unhealthy blood vessels in the eye as well as laser procedures that use light beams to close abnormal ones may also help.

Lucentis (Ranibizumab) and Eylea (Aflibercept) are two commonly prescribed drugs to treat wet form macular degeneration, specifically targeting an enzyme known as VEGF that promotes abnormal blood vessel formation in the body. Both treatments have proven successful at relieving symptoms associated with wet macular degeneration while not always restoring lost vision; due to this condition’s tendency for recurrence they should continue taking these long-term.

RPE cells are vital components of our eyes; they convert light into electrical signals that the brain then interprets as visual images. By differentiating RPE from human embryonic stem cells or induced pluripotent stem cells, an almost unlimited source of replacement cells may become available; such cells have already shown promise in animal models of retinal degeneration as well as some people with early AMD; however, significant ethical, regulatory, and technical challenges must still be overcome before these cell therapies become widely available.

Laser treatment

Under “wet” macular degeneration, abnormal blood vessels form beneath the retina and begin leaking fluid, damaging macula cells and leading to vision loss. Laser treatment seals off these abnormal vessels – not necessarily restoring lost vision but slowing progression and helping preserve eyesight – in an approach known as laser photocoagulation.

People living with wet AMD may develop scar tissue within their retinal pigment epithelium layer of cells that detect light and transmit signals to the brain for images on the retina. This scar tissue prevents light absorption by the retina and results in dim or blurry vision; focal laser photocoagulation may be recommended to help alleviate this type of macular degeneration and enable more light absorption from entering, thus improving vision. This laser beam technique uses heat energy to burn away scar tissue to allow greater retinal light absorption and thus better vision overall.

Scientists have made great advances in developing drugs to treat both dry and wet macular degeneration. Some of these new medicines block vascular endothelial growth factor (VEGF), a protein which encourages new blood vessel formation that bleeds onto retina, damaging retina. Medication may be administered either as eye drops or by injection directly into eye.

Other experimental treatments for wet macular degeneration involve transplanting retinal pigment epithelium from human embryonic stem cells, using UC Davis Health researchers’ techniques. Furthermore, they created a device to implant these cells directly beneath the retina where they can continue functioning normally.

Bevaciranib, a drug designed to block VEGF, has recently been the subject of an intensive phase 3 clinical trial taking place across 93 sites nationwide and shown significant promise in improving vision in those living with wet macular degeneration.

Studies have demonstrated the efficacy of laser therapy in reducing soft drusen deposits found beneath the retina as early signs of macular degeneration. Some research indicates that using this laser technology to remove these drusen may prevent new blood vessel growth and further vision loss.

Injections

Current treatments for wet macular degeneration involve monthly injections of anti-VEGF agents – drugs which reduce leaky blood vessel growth – into the eyes. While such injections are effective at slowing disease progression and improving vision in many patients, returning each month for these injections may prove challenging, leading to missed appointments and worsening of vision.

Researchers are exploring whether medications such as Aflibercept (Macugen) can be given on an as-needed basis in order to make treatment more accessible, as researchers investigate its effect. One such study published by Graefe’s Archive for Clinical and Experimental Ophthalmology shows that taking it on demand proved no less effective than adhering to a fixed monthly schedule – promising patients don’t need commit to such regimens for them to benefit.

An as-needed administration of Aflibercept was linked with better visual acuity improvement than monthly injections. Aflibercept works by binding to a protein that blocks VEGF from being released, thus decreasing leaking blood vessels and stopping their formation altogether. Furthermore, this medication was shown to have additional beneficial results when combined with treatments like bevacizumab or ranibizumab for enhanced results.

Even though this treatment remains experimental, it shows promise for those suffering from wet macular degeneration. Scientists continue their investigation of other potential drugs to treat this form of the condition; for instance, one study discovered that taking an antidepressant called fluoxetine had similar results as anti-VEGF medication in terms of inhibiting new blood vessel formation.

Many steps have been taken in recent years to combat or even cure this disabling condition, including developing more accurate diagnostic tools to spot it early and testing supplements that may mitigate retinal damage, and creating portable or home technology that enables people with ARMD to monitor their vision at home. Research into genes linked to its development is also expanding quickly.