Overview
Wet macular degeneration is a long-lasting eye disorder characterized by blurred vision or a blind spot in the central vision. It occurs when blood vessels leak fluid or blood into the macula, the part of the retina responsible for clear central vision. Wet macular degeneration is one of two types of age-related macular degeneration, and it typically begins as the dry type. Early detection and treatment may help reduce vision loss and, in some cases, recover vision. Symptoms include visual distortions and reduced central vision in one or both eyes.
Understanding the disease
Symptoms
Wet macular degeneration symptoms usually appear suddenly and worsen quickly. They may include:
- Visual distortions, such as straight lines seeming bent.
- Reduced central vision in one or both eyes.
- The need for brighter light when reading or doing close-up work.
- Difficulty adjusting to low light levels, such as when entering a dimly lit restaurant or theater.
- Increased blurriness of printed words.
- Difficulty recognizing faces.
- A well-defined blurry spot or blind spot in the field of vision. These symptoms may cause a significant impact on daily activities like reading, driving, and recognizing faces. If you experience any of these symptoms, it is important to see an eye doctor for a proper evaluation and timely treatment.
Risk Factors
Risk factors for developing wet macular degeneration include age (most common in people over 55), family history and genetics (the disease has a genetic component), race (macular degeneration is more common in white people), smoking (smokers are more likely to develop the condition), and obesity (being obese may increase the risk of the disease progressing to a more severe form). Cardiovascular disease, or having diseases that affect the heart and blood vessels, may also increase the risk of developing wet macular degeneration.
Development
Wet macular degeneration can develop in two ways:
- Choroidal neovascularization: Irregular new blood vessels grow from the choroid under and into the macula. These blood vessels may leak fluid or blood, affecting the retina's function.
- Fluid buildup in the back of the eye: Fluid leaks from the choroid and collects between the retinal pigment epithelium and the retina or within the layers of the retina. This may cause irregularities in the macula layers, resulting in vision loss or distortion.
Assessment and Diagnosis
Triage
You should see a doctor if wet macular degeneration is suspected when you notice changes in your central vision, lose the ability to see fine detail, or experience any of the symptoms listed, such as visual distortions, reduced central vision, the need for brighter light, difficulty adjusting to low light levels, increased blurriness of printed words, difficulty recognizing faces, or a well-defined blurry spot or blind spot in the field of vision.
Diagnosis
To diagnose wet macular degeneration, your eye doctor will likely review your medical and family history, conduct a complete eye exam, and perform additional tests, such as:
- Examination of the back of your eye: Your eye doctor will put drops in your eyes to dilate them, then use a special instrument to examine the back of your eye for fluid, blood, or a mottled appearance caused by yellow deposits (drusen).
- A test for changes in the center of your vision: During an eye exam, your eye doctor may use an Amsler grid to test for changes in your central vision. If you have wet macular degeneration, the straight lines in the grid may appear faded, broken, or distorted.
- Fluorescein angiography: In this test, your eye doctor injects a dye into a vein in your arm, and a special camera takes pictures as the dye travels through the blood vessels in your eye. The images will show if there are retinal or blood vessel changes, which are a sign of wet macular degeneration.
- Optical coherence tomography (OCT): This noninvasive imaging test displays detailed cross-sectional images of the retina, identifying areas where the retina may be thinning, thickening, or swelling due to fluid buildup from leaking blood vessels. These tests will help your eye doctor determine if you have wet macular degeneration and recommend appropriate treatment options.
Management and Treatment
Complications
Potential complications of wet macular degeneration include depression, social isolation, and Charles Bonnet syndrome. People with advanced wet macular degeneration that causes central vision loss are at higher risk of experiencing these complications. Charles Bonnet syndrome is a condition where visual hallucinations occur due to profound vision loss.
Treatment
Treatment options for wet macular degeneration may include medication, photodynamic therapy, and eye injections. Medications: Anti-VEGF drugs, such as Bevacizumab (Avastin), Ranibizumab (Lucentis), Aflibercept (Eylea), and Brolucizumab (Beovu), are commonly used to stop the growth of new blood vessels in wet macular degeneration. Photodynamic therapy: This procedure involves injecting a medicine called verteporfin (Visudyne) into a vein and then using a laser to activate the medicine, causing problem blood vessels to close. However, this treatment is less common than anti-VEGF injections. Eye injections: Your eye doctor can inject the anti-VEGF medications directly into the affected eye to slow disease progression and preserve existing vision. These injections may need to be repeated every 4 to 6 weeks to maintain their effectiveness. Possible risks of eye injections include conjunctival hemorrhage, increased eye pressure, infection, retinal detachment, and eye inflammation. Remember that it is essential to consult an eye doctor for a proper diagnosis and personalized treatment plan.
Preparing for medical consultation
To prepare for an appointment for wet macular degeneration, follow these steps:
- Make an appointment with an eye doctor who specializes in macular degeneration, such as an ophthalmologist or retina specialist.
- When you make the appointment, ask if you need to do anything to prepare, like fasting for specific tests or bringing any previous test results.
- List any symptoms you're experiencing, including those that seem unrelated to your vision problem.
- List all medications, vitamins, and supplements you take, including doses.
- Ask a family member or friend to accompany you to the appointment, as your vision may be affected after the dilated eye exam. On the day of the appointment, be prepared to discuss your medical and family history, as well as any recent changes in your vision. Your doctor will perform a comprehensive eye exam, which may include dilating your eyes, examining the back of your eye, and using an Amsler grid to test for changes in your central vision. After the exam, your doctor will provide you with information about your condition, including diagnosis, treatment options, and potential lifestyle changes to protect your vision.