Wet macular degeneration Is a progressive eye disease that causes central vision loss. The macula is the area of the retinal responsible for the detailed part of your vision. It Is where the photoreceptors are the most densely packed. Like pixels on a TV, the more there are the better the picture. Abnormal blood vessel formation in this area become leaky and bleed causing a lack of oxygen in this vital area, which causes the photoreceptors to be damaged or essentially die.
These new blood vessels (known as choroidal neovascularization or CNV) form beneath the retina and macula in the “wet” kind of macular degeneration. These new blood vessels may bleed and leak fluid, causing the macula to expand or raise up from its typical flat posture, distorting or obliterating central vision. Vision loss can be quick and severe in certain situations.
Due to blood or fluid behind the macula, individuals with the “wet” type may see a black spot (or spots) in the center of their vision. Because the macula is no longer smooth, straight lines may appear wavy. Side vision, often known as “peripheral vision,” is rarely impacted. Despite the onset of neovascularization, some patients do not perceive any such changes. Because of this, annual eye exams should be performed at a minimum.
There are two types of choroidal neovascularization. Vessels underlying the retinal pigment epithelium are referred to as type 1 choroidal neovascularization (CNV) (RPE). Vessels extending into the subretinal space between the neurosensory retina and the RPE are referred to as type 2 CNV. Type 1 or classic form is well-defined and usually more aggressive, it results in vision of 20/250 to 20/400, but it can be worse than 20/800 in some cases. The average visual acuity for eyes with the occult form is slightly superior, ranging between 20/80 and 20/200. Occult lesions are less well-defined and have less leaking than visible lesions.
Angiography is required to diagnose a classic CNV. The definition is crucial in clinical practice since it influences therapy selection. Exudative age-related macular degeneration (AMD) can cause a classic CNV, but it can also be caused by other chorioretinal disorders. This angiographic image is based on newly created fibrovascular networks that emerge out of the choriocapillaris through the Bruch membrane between the retina and the retinal pigment epithelium (RPE). Classic CNVs are thus more defined in angiography than occult CNVs, which mostly proliferate under the RPE.
Metamorphop- sia, (wavey or distorted vision) worsening in visual acuity, and central visual field abnormalities are the first signs of classic CNV. The Metamorphopsia is usually more subtle in the occult form due to it being more diffuse and spread over a larger area of the retina. The acuity may be more stable also. Making it harder for the patient to know they have an issue.
Medications that limit the impact of growth signals sent by the body to develop new blood vessels may assist to stop the growth of new blood vessels. These medications are the first-line treatment for wet macular degeneration at any stage. These drugs are injected into the afflicted eye by your doctor. To keep the medication’s favorable impact, you may need injections every four to six weeks. As the blood vessels contract and the fluid under the retina absorbs, you may be able to partially regain eyesight in some cases.
- Bevacizumab (Avastin)
- Ranibizumab (Lucentis)
- Aflibercept (Eylea)
- Brolucizumab (Beovu)
A high-energy laser beam is used by your doctor to seal aberrant blood vessels under the macula during photocoagulation therapy. The laser creates scarring, which can result in a blind spot, but it is used to stop blood vessels from bleeding and prevent additional damage to the macula. Blood vessels may regenerate despite this treatment, necessitating subsequent treatment.
This used to be the treatment of choice prior to the anti-VEGF injections, however, it is rarely used due to the effectiveness of the medications. It still has its place in certain conditions. This treatment is only performed extremely seldom to correct aberrant blood vessels in the macula’s center. A medication called verteporfin (Visudyne) is injected into a vein in your arm and travels to blood vessels in your eye during photodynamic therapy. Your doctor uses a special laser to focus a focused beam of light on the aberrant blood vessels in your eye. This activates the medication, causing aberrant blood vessels to shut and the leakage to halt.
Rehabilitation through low vision clinics. AMD does not impact your peripheral vision and seldom results in total blindness. However, it has the potential to diminish or remove your center vision, which is required for driving, reading, and recognizing faces. Working with a low vision rehabilitation specialist, an occupational therapist, your eye doctor, and others educated in low vision rehabilitation may be effective. They can assist you in figuring out how to adjust to your changing vision.
Whether there is a visual loss, once CNV has established in one eye, the other eye is at a high risk of developing the same condition. If all four risk factors are present— systemic hypertension, large drusen, more than five drusen and pigment clumping, the five-year probability of CNV in the second eye is 87 percent, while the risk is just 7% if none of them are present.
How fast does wet macular degeneration progress?
This depends greatly on many other related conditions and risk factors. Some of these risk factors can be controlled and a few can’t. If you smoke, your eyes are continuously battling free radicals and blood vessel damage, preventing oxygen and nutrients from reaching the retina. Many AMD sufferers have inherited genes or blue eyes, both of which contribute to the illness. Food choices have a significant impact on the health of the macula, and those who consume an antioxidant-rich diet and eat anti-inflammatory foods may be able to improve their eye health.
If left untreated, wet AMD advances swiftly, and visual loss can occur within days. That’s why it’s critical to have your eyes checked often and to follow your ophthalmologist’s instructions for home screenings (such as the Amsler Chart).
Can I still drive with wet AMD?
The macula, which is located in the center of the retina, can be affected by wet macular degeneration. The ability to read an eye chart is the most widely recognized test of macular function. The “Snellen” eye chart has measurements ranging from 20/20, which is ideal, to 20/200, which is deemed “legally blind.” The eye chart measurement is always “best corrected visual acuity,” meaning it is taken with the best corrective glasses or contact lenses available. In many states, this includes the use of bioptic telescope glasses to get the best possible visual acuity to pass the driver’s test and continue driving. The requirement in each state is different, for many, the minimum is 20/40.
Even without moving our eyes or heads, we have an uninterrupted visual field of around 180 degrees horizontally when both eyes are operating normally. Our peripheral retinas give critical information about other cars and pedestrians, while our maculas provide the high acuity vision required to read street signs. Because these retinal cells are more sensitive to motion, we can notice a moving item much faster than a stationary one. These peripheral cells are not damaged by wet macular degeneration, therefore it is just the central vision that is disrupted. So depending on the severity of the central vision loss driving may still be an option with or without low vision aids.
Can wet macular degeneration be reversed?
If wet AMD is caught early the anti-VEGF treatments may reverse some of the initial vision loss and visual distortion caused by the fluid under the retina. However, if the condition remains untreated for a long period of time the likelihood of fibrotic scarring occurring increases. Once the scarring is there the vision loss is permanent.
Which is worse the dry or wet form of macular degeneration?
Wet macular degeneration is the end stage of the disease. The early stages are the dry stages and consist of what are called drusen. Drusen are deposits under Bruch’s membrane that consist of cellular waste the isn’t being cleared by the body properly. When these drusen become larger it is the intermediate stage and when they finally break through the membrane it allows fluid to enter the innermost layers of the retina and then the new blood vessel formation occurs and it converts to the wet form of macular degeneration.
Are there any new treatments options available?
Longer Lasting medications
Anti-VEGF injections have been used to treat wet AMD by ophthalmologists with significant effectiveness since 2005. This treatment, however, necessitates regular injections every 4 to 8 weeks, which might be difficult for some people to stick to. To avoid abnormal blood vessel formation, longer-lasting anti-VEGF injections necessitate fewer medical visits.
Beovu, one of four existing treatments for wet AMD, shows potential as a longer-lasting anti-VEGF injection. Maintenance Beovu injections can be spaced as far apart as 12 weeks.
PDS or Port Delivery System
A doctor can also use the port delivery system (PDS) to provide anti-VEGF medication. The PDS is a tiny eye reservoir that is surgically implanted and contains medication for controlled and continuous release into your eye.
A doctor uses a specialized syringe to refill the device. A PDS can store many months’ worth of medication, reducing the number of trips to the doctor. The PDS is currently in its early stages of development and is not yet accessible for widespread usage.
The goal of gene therapy is to allow your eyes to stop the action of VEGF in your eyes and prevent aberrant blood vessel growth. Repeated injections or implants are no longer necessary. Gene therapy includes injecting a harmless virus with an anti-VEGF gene into your eye. This is accomplished in a single treatment, either through a surgical operation beneath the retina or through an injection into the eye. Hopefully, this will be available in the next few years.
Anti-VEGF eyedrops that may be used at home instead of obtaining injections at the doctor’s office would be a more pleasant and convenient solution. Anti-VEGF medicines were delivered as eye drops, combined with cell-penetrating peptides (CPPs), into the eyes of mice, rats, and pigs, and were as effective as an anti-VEGF injection, according to a study published in Investigative Ophthalmology & Visual Science.
X-82 is an anti-VEGF drug that can be used orally. Despite the fact that 60% of the 25 study participants did not require anti-VEGF injections, there were some significant side effects, such as diarrhea and nausea.
The efficacy of a treatment can be improved by combining drugs. Combining the use of an eye drop called Cosopt (dorzolamide-timolol) with anti-VEGF injections lowers the development of fluid in the retina more effectively than injections alone, according to studies.
Wet AMD is a disease characterized by aberrant blood vessel development. Radiation can be used to inhibit the growth of specific cells. The use of radiation to treat wet AMD has decreased since anti-VEGF treatments have proven to be more effective. The two treatments, on the other hand, may complement one other.
Anti-VEGF injections work immediately but must be repeated, whereas radiation takes longer to function but provides longer-lasting effects. More research is needed to see if combining anti-VEGF treatment with radiation therapy will improve treatment outcomes.