Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in industrialized countries and manifests itself in two clinical subtypes – Dry AMD and Wet AMD, also referred to as Neovascular or Exudative AMD.

Wet AMD occurs when abnormal blood vessels proliferate beneath the retina and leak blood and fluid, often rapidly progressing to cause severe vision loss. Although less common, wet AMD can quickly progress leading to severe vision impairment.

Anti-VEGF Injections

Current treatments for wet macular degeneration involve monthly injections of an anti-vascular endothelial growth factor (VEGF) drug into one eye to reduce abnormal blood vessel growth and fluid leakage in the macula, the central region of retina which allows us to see details clearly. Studies have proven this treatment slow further vision loss while improving visual acuity; however, side effects may still occur.

Patients needing injections must return monthly to their doctor’s office or clinic, which may be challenging for those with limited mobility and other commitments. Missing even one treatment could compromise your vision further and carry risks like endophthalmitis and vitreous hemorrhage which must also be considered when managing intraocular inflammation.

Some patients have discontinued treatment altogether due to these side effects; others have experienced geographic atrophy (GA), an advanced form of AMD where central and straight-ahead vision are gradually lost over time. While GA may not directly be caused by anti-VEGF injections, its frequency has been linked with it.

Bevacizumab (Avastin) and aflibercept (Eylea HD), two anti-VEGF drugs used for these injections, work by inhibiting the formation of new blood vessels that form in wet AMD’s exudative form, called exudative AMD exudative form. As these new vessels bleed into and leak fluid under the retina, blurring central vision quickly while leading to rapid visual acuity decline. By performing fundus fluorescein angiography tests on these leaking new vessels, doctors can see their extent and pattern within.

Though these side effects may occur, many wet macular degeneration patients find the improvements to visual acuity brought about by bevacizumab and other VEGF medications worth continuing treatment with. Furthermore, Genentech recently approved faricimab (Vabysmo), which requires less frequent injections than its competitors and could help improve vision acuity outcomes more rapidly than current standard-bearers.

Randomized clinical trials involving large numbers of wet macular degeneration patients will be necessary to establish effective guidelines for safely weaning off anti-VEGF therapies. Meanwhile, physicians can monitor patient responses to such treatment and offer treatment pauses when no signs of fluid accumulation or progression appear.

Photodynamic Therapy

Photodynamic therapy, also known as photodynamic cell death therapy (PDCT), employs light to destroy cancerous or precancerous skin cells. It works by using Levulan (an oral chemical solution) combined with blue light treatment and targeting specific tissues for treatment. Once activated by blue light exposure, Levulan causes cells to be damaged which, once damaged, allows oxygen from blood streams nearby to destroy all surrounding cells resulting in cell-death reactions and removal of lesions or tumors. Photodynamic therapy is most frequently used to treat actinic keratosis although other applications exist including advanced T-cell lymphomas basal cell carcinoma Barrett esophagus and early squamous cell skin cancer.

Wet macular degeneration (WMD) is caused by abnormal growth of blood vessels that leak fluid and debris into the macula, altering its function in ways not normally associated with eye function and leading to rapid loss of central vision that may ultimately lead to blindness. Treatments targeting vascular endothelial growth factor (VEGF) may slow or stop new blood vessel growth in order to delay or stop further vision loss; however, regular or bimonthly injections of anti-VEGF drugs remain necessary – often becoming an obstacle to care among many patients.

Johns Hopkins Medicine researchers recently conducted a study of 106 individuals living with wet age-related macular degeneration who may be eligible to discontinue receiving the monthly injections currently recommended for treating their condition, suggesting up to one third could safely discontinue injections without suffering further vision loss. Their findings are further proof of this theory and add credence to arguments suggesting some can safely stop receiving injections without experiencing further vision loss.

At the center of this study, people living with wet macular degeneration were given regular injections of Aflibercept – an anti-VEGF and angiogenesis inhibitor drug – and then monitored for progression as well as any signs of retinal disease like leaking fluids, abnormal blood vessels or distortion of straight lines. Researchers discovered that those who stopped receiving injections did not suffer further vision loss.

Laser Surgery

Laser surgery is increasingly being utilized as an effective solution for cataract and age related macular degeneration (ARMD) treatments, among others. Utilizing an intense beam of light that can be focused on specific areas, laser surgery often has reduced blood loss and infection risks and is performed more safely than traditional surgeries in doctor offices or outpatient facilities such as hospitals or clinics.

Wet ARMD occurs when the macula, part of the retina at the back of the eye, becomes damaged due to abnormal blood vessels emerging between two layers of tissue and becoming compromised with leakage from these new blood vessels, leading to blurred central vision and characteristically waviness or fuzziness in straight lines.

Anti-VEGF medication is the go-to therapy for wet ARMD, blocking an activity protein responsible for stimulating new blood vessel formation. When administered as injections into vitreous fluid of eye, typically in combination with photosensitizing agents to allow laser attacks against and destroy new neovascular growths, anti-VEGFs can delay severe vision loss due to wet macular degeneration. They should typically be taken on an ongoing basis; monthly administration can delay further vision loss from wet macular degeneration.

Few patients with wet ARMD suffer from leaky new blood vessels that cannot be addressed with anti-VEGF therapy alone. One treatment option available to these individuals is laser surgery called YAG laser capsulotomy, in which laser beams are used to make an opening in the natural capsular bag holding in their intraocular lens implant (IOL) safely in its place. This procedure can be completed quickly and safely within minutes in your doctor’s office and can help improve vision quality significantly.

Those experiencing vision loss due to age-related macular degeneration should contact us as soon as possible for a comprehensive evaluation and treatment plan. Our doctors will answer all your questions while helping preserve your vision.

Other Treatments

Age-related macular degeneration (ARMD) affects the macula of the retina at the back of the eye, leading to central vision deterioration that makes reading, driving and recognising colors and faces difficult. A healthy diet and lifestyle can slow the progression of ARMD and delay vision loss.

ARMD can be divided into two clinical subtypes, dry ARMD (also referred to as atrophic macular degeneration) and wet ARMD, which occurs when abnormal blood vessels form beneath the retina and leak blood or fluid into the macula, leading to rapid vision loss in central vision areas. Wet ARMD accounts for 10% to 15% of advanced cases of ARMD; rapid vision loss often follows severe cases.

Wet ARMD can be treated effectively using injections of anti-VEGF medication, which works by blocking the abnormal new blood vessels that cause wet ARMD. Anti-VEGF injections may prevent further vision loss and in 40% of patients can even lead to improved central vision.

Photodynamic therapy with verteporfin may provide another effective option, consisting of injecting the drug directly into the eyes before using a low energy laser light beam to destroy growing new blood vessels on the retina. This treatment has proven more successful than anti-VEGF injections alone in slowing vision loss or improving visual quality.

Non-drug treatments for wet macular degeneration include lifestyle aids like magnifying glasses, tape-recorded books and magazines, large print playing cards, talking clocks and scales and other devices that may help. Your eye doctor can advise on which options might work for you.

Early identification and intervention are of utmost importance in managing macular degeneration. Regular eye exams are necessary to detect AMD in its earliest stages and provide you with effective treatments options. Your doctor can suggest diet modifications and nutritional supplements that can slow the progression of AMD; in addition, low vision aids may make living with its symptoms easier. Please reach out today for a consultation session; our ophthalmologists specialize in many diseases and can recommend what might work best in your specific situation.