Wet Macular degeneration is one of two types of macular degeneration.  Dry macular degeneration is the other type.  Most people start out with the dry form and can progress to the wet form.  The Wet form happens when small blood vessels form and are very fragile.  These fragile blood vessels can easily break causing fluid to be in the retinal tissue which causes damage.  The differences between the wet and dry form are as they sound, the dry form doesn’t have any fluid accumulation, however, there is an accumulation of small deposits which are called drusen and an overall thinning of the retinal tissue.  Wet macular degeneration always starts out as dry.

The Symptoms

Wet macular degeneration causes sudden changes in your vision, you may start to see blurred spots, wavy lines, or even complete blind spots in the central part of your vision.   This will immediately affect your ability to see text for reading and writing, your ability to see street signs when driving, and possible even the ability to see loved ones’ faces.

These symptoms may get worse if it goes untreated and the longer it goes the more permanent the damage.

What should you do if you notice these symptoms?

The first thing is to schedule an appointment with your eye doctor.  Chances are you have already been seeing a retinal specialist for the dry form of macular degeneration, so you should get in to see them as soon as possible.  If you haven’t been seen for an eye exam recently and haven’t been diagnosed with the dry form of macular degeneration, then an appointment with an optometrist or general ophthalmologist is probably warranted first. There may be other conditions that. Are actually the problem such as cataracts.

How will they determine if it is Wet macular degeneration?

Diagnosis

Several tests will be done by your doctor to determine if it is the wet form of macular degeneration.

• A dilated eye exam will be the first thing done to visually see if there is drusen ( the dry form) or if they can visually see fluid and elevation of the retina. This part of the exam is uncomfortable due to the bright lights but not painful.
• Amsler grid may be the next test to determine how much the functionality of your vision is being affected. This is just a grid-like pattern on a piece of paper in which you tell how distorted the lines are or if they are missing.
• Angiography will likely be next, this is a dye test that is injected into a vein of your arm which will travel to the eye. There are two types of dyes, one will show fluid that has leaked and one will show the abnormal blood vessels.
• OCT or Optical Coherence tomography will also be a likely test that will be done. This machine is non-invasive and shows cross-sectional views of the retina to determine if there is thining or swelling in the retinal tissue. This will also be useful for following the progress of the treatments of wet macular degeneration.

Treatment

Injections

The most likely treatment of your wet macular degeneration is going to be an injection of a medication into the eye.  There are several medications that are currently being used for this.  They all are used to cause the growth factors of the new blood vessels to stop the new growth.

Do the shots in the eye hurt?

As with all shots, there may be a slight tinge of pain just as the needle pierces the eye, but there are no pain receptors on the inside of the eye.  You may have a small conjunctival hemorrhage at the site of the injection, and other possible side effects include increased pressure of the eye, inflammation, and or infection.  Most of these are rare though.

How many shots are needed?

Depending on the severity of the fluid in your macula and the amount of blood vessel growth that has already occurred will determine the amount of injections that may be needed. Most people will likely need them initially about every 4-6 weeks. 6-8 shots a year are likely needed to control the blood vessel growth. Some people may need more and some less.

How effective are the injections?

The most current research shows that for those that have the injections, 25-34% of having an increase in vision as compared to only 5% of those who don’t have the treatment.

Photodynamic therapy. This therapy involves your doctor injecting a drug into a vein of the arm that will travel to your eye and into the new fragile, leaky blood vessels. A light is then applied to those blood vessels which will activate the drug and cause it to close the new blood vessels.  This is pretty effective at stopping the leaking and blood vessel growth, however, more treatments may be needed to maintain the progress.  Care must be taken to avoid sunlight after this treatment until the drug has cleared the body.

Photocoagulation is a much less used therapy.  This is where a laser is used to cauterize the new, leaky blood vessels. However, this causes scarring to the retinal tissue and a loss of vision may result.  Most people who have wet macular degeneration aren’t candidates for this type of procedure. It is only used in certain cases and when the blood vessels are directly below the macula.

Low vision rehabilitation. If permanent damage has occurred and your vision has been compromised then the next step would be to see a low vision specialist.  Their job is to help you maximize your remaining vision. They will prescribe devices and special glasses to help you continue to retain your independence and hopefully continue to do all your normal daily activities.

Are there any new therapies?

There are some exciting new treatments on the horizon for wet macular degeneration. Even though the current treatments have been revolutionary and have saved the vision of so many. They still require many visits to the retinal specialist and for many elderly patients that can be difficult especially give the visual limitations. So even though the current treatments with injections are probably 90% effective at stopping vision loss the actual number is probably only 50% due to patients not getting enough treatments.  So the goal is to find new methods for stopping the blood vessel growth that occurs in patients with wet macular degeneration without needing so many treatments or injections.  The most promising new treatment seems to be gene therapy.

Gene therapy for wet macular degeneration is a promising new alternative to ongoing injections. The goal would be to have a one-time treatment that would accomplish the same thing as all the ongoing injections.  The treatment could be a one-time injection under the retina that causes the eye to make its own anti-VEGF (which is what the injections are) or an injection into the vitreous just like the current injections.

New deliver methods to the eye

A new drug deliver method that is being tested is a port delivery system.  This is a tiny refillable device that continuously releases the anti-VEGF instead of having to have ongoing injections.  This may reduce the doctor’s visits to once or twice a year to refill the device.

Multifunctional injections

New drugs that treat multiple causes of wet macular degeneration are now being tested. The new treatment would treat more than one cause of the new blood vessel growth, which is believed to have a longer-lasting effect. So the injections may only be needed every 4 months.

New longer lasting anti-VEGF medications

Many of the drug makers are working on new versions of the anti-VEGF meds that last longer and don’t need to be injected into the eye as often.  Beovu is a new drug by Novartis that has been approved for use in the USA and for one in every three patients they only need the injections every three months.  Abicipar is allergans new drug and has a similar treatment schedule.  Sunitinib is another drug in its phase 3 clinical trials that has the potential for patients to go 6 months in between injections.

Does wet macular degeneration come back?

For many, the treatments may have to be ongoing to maintain the status quo. For others, a few treatments may be all that is needed to stop the leaking and the blood vessel growth.

Will you go blind for wet macular degeneration?

Neither form of macular degeneration even in its worst form or outcome causes complete blindness. It affects the central vision which can be very devastating to overall vision because that is the part of our retina and visual field that gives us our detailed vision. It can affect our ability to read and write, see faces, drive a car, and many other detail-oriented tasks.  In some cases, people may end up legally blind which means that their visual acuity is 20/200 or less, however, they will retain their peripheral vision.  Hopefully, if treatment is initiated soon enough and with the help of low vision doctors and devices that won’t be the case.

How long does it take to become legally blind from wet macular degeneration?

Wet Macular degeneration happens fast. It will occur in a sudden change in your vision most likely for the worse when the newly formed blood vessels become leaky.  So the vision and acuity will have an immediate reduction.  The severity will be different for everyone.  The sooner treatment is initiated the better the prognosis for the long-term vision.  For many, the treatments will stop the decline in vision and as the fluid is dried up will return much of the vision that was suddenly lost. For some, the vision may initially get better but then slowly over time deteriorate even with treatment.  The key is prevention and getting treatment as quickly as possible.

Can wet macular degeneration be prevented?

There are certain things that you can do to reduce your risk of getting wet macular degeneration as well as the dry form.  The biggest risk factor is smoking. You are far more likely to get macular degeneration and it is also more likely to progress if you are a smoker.

Eating lots of green leafy vegetables and taking an AREDS 2 supplement can reduce your risk by about 25%.  Diet and exercise will reduce your risk my keeping your cholesterol and saturated fats in check.

Regular eye exams should be scheduled every year over the age of 50 and more if there are familial risk factors or if your doctor finds that you have the beginning of macular degeneration.

Can someone with wet macular degeneration still drive and maintain their independence?

As with anything, the severity of the damage and the timeliness of the treatment will play a role in the outcome and abilities of the patient. However with help from low vision specialists and a low vision occupational therapist. People can be taught to adapt and to use special devices to overcome many of the disabilities that may result from vision loss.  Special glasses can be prescribed such as a bioptic telescope that may give enough magnification to continue to drive and be able to see street signs.

Wet macular degeneration is a visually devastating disease.  All should be done to prevent it and one should know the initial symptoms to get treatment as soon as possible.