Description

Wet macular degeneration is a disease of the eye that causes blurred or reduced central vision. It is a type of age-related macular degeneration where the blood vessels that leak fluid or blood in the part of the retina known as the macula (MAK-u-luh). The macula is responsible for central vision.

Wet macular degeneration is one of the two types of macular degeneration. The other type, dry macular degeneration is more common and less severe. The wet-type always starts as the dry type.

The early detection and the treatment of wet macular degeneration can help to reduce the loss of vision. In some cases, early treatment can restore lost vision.

Symptoms

Wet macular degeneration symptoms usually appear suddenly and get worse quickly. They may include:

  • Visual distortions, such as straight lines appear to be bent.
  • Reduced central vision in one or both eyes.
  • The need for brighter light when reading or doing the work.
  • Difficulty adapting to low light levels, such as when entering a dim restaurant or a theatre.
  • The increasing blurriness of printed words.
  • Difficulty recognizing faces.
  • A well-defined blurry spot or blind spot in your field of vision.

Macular degeneration does not affect side vision, so it doesn't cause total blindness.

When to see a doctor

See your eye doctor if:

  • You notice changes in your central vision.
  • You lose the ability to see the details.

These changes may be the first sign of macular degeneration, especially if you are older than 60 years of age.

Causes

No one knows the exact cause of the wet macular degeneration, but it develops in people who have dry macular degeneration. Of all the people with age-related macular degeneration, approximately 20% have the wet form.

Wet macular degeneration can develop in different ways:

  • The loss of vision caused by the irregular growth of the blood vessels. Sometimes the formation of new blood vessels from the choroid under and in the macula. This growth is not typical, and when this happens it is known as choroidal neovascularization. The choroid is the layer of blood vessels between the retina and the outer, firm layer of the eye, called the sclera. These blood vessels may leak fluid or blood, which affect the retina of the function, and that leads to loss of vision.
  • The loss of vision caused by the accumulation of fluid in the back of the eye. When fluid leaks from the choroid, you can collect between the thin layer of cells called 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.

Risk factors

Factors that may increase the risk of macular degeneration include:

  • Age. This disease is more common in people older than 50 years.
  • Family history and genetics. This disease has a hereditary component, which means that you can run in families. Researchers have identified several genes associated with the condition.
  • Of the race. Macular degeneration is more common in white people.
  • The habit of smoking. Smoking or being exposed to tobacco smoke on a regular basis greatly increases the risk of macular degeneration.
  • Obesity. The research suggests that obesity may increase the likelihood of early or intermediate age-related macular degeneration will progress to a more severe form of the disease.
  • Cardiovascular disease. If you have diseases that affect the heart and blood vessels, you may be at greater risk of macular degeneration.

Complications

The people whose wet macular degeneration has progressed to the loss of central vision have a greater risk of depression and social isolation. With profound loss of vision, people may see visual hallucinations. This condition is known as Charles Bonnet syndrome.

Prevention

It is important to have routine eye exams to detect early signs of macular degeneration. The following measures can help reduce the risk of developing wet macular degeneration:

  • Manage all the other medical conditions. For example, if you have a cardiovascular disease or high blood pressure, take the medication and follow your health care team instructions for the control of the condition.
  • Do not smoke. People who smoke are more likely to develop macular degeneration than are people who do not smoke. Ask a health care professional to help you stop smoking.
  • Maintain a healthy weight, and exercising regularly. If you need to lose weight, reduce the number of calories you eat and increase the amount of exercise each day.
  • Choose a diet rich in fruits and vegetables. These foods contain vitamins antioxidants that reduce the risk of developing macular degeneration.
  • To include fish in your diet. Omega-3 fatty acids, found in fish, may reduce the risk of macular degeneration. Nuts such as walnuts also contain omega-3 fatty acids.

Diagnosis

For the diagnosis of wet macular degeneration, an eye doctor typically reviews the medical and family history and do a complete examination of the eyes. To confirm a diagnosis of macular degeneration, an eye doctor may suggest other tests, including:

  • Examination of the back of the eye. An eye doctor puts drops in your eyes to dilate, and used a special tool to examine the back of the eye. The eye care professional will look for a mottled appearance that's caused by yellow deposits that form under the retina called drusen. People with macular degeneration often have many drusen.
  • A test of the changes in the center of the field of vision. An Amsler grid can be used to test for changes in the center of the field of vision. In macular degeneration, some of the straight lines in the grid may look faded, broken, or deformed.
  • The fluorescein angiography. During this test, an eye, a doctor injects a dye into a vein in the arm. The dye travels to and highlights the blood vessels in the eye. A special camera takes pictures as the dye travels through the blood vessels. The images can show leakage of the blood vessels or changes in the retina.
  • Indocyanine green angiography. As fluorescein angiography, this test uses a contrast medium is injected. Can be used to confirm the findings of fluorescein angiography, or to identify the problem blood vessels deeper in the retina.
  • The optical coherence tomography. This non-invasive imaging test of the detailed display of the cross-sections of the retina. Identifies areas of thinning, thickening or swelling. This test is also used to help control how the retina responds to age-related macular degeneration treatments.
  • The optical coherence tomography (OCT) angiography. This non-invasive imaging test of the detailed display of the cross-sections of the retina. Identifies areas of thinning, thickening or swelling. These can be caused by the accumulation of fluid leakage from the blood vessels in and under the retina.

Treatment

There are treatments that can help slow the progression of the disease and preserve vision. If you start early enough, treatment can recover some of the lost vision.

Medications

Some drugs, called anti-VEGF drugs, may help stop the growth of new blood vessels. These drugs block the effects of the growth of the signals that the body sends to generate new blood vessels. It is considered the first line of treatment for all stages of the wet macular degeneration.

Drugs used to treat wet macular degeneration include:

  • Bevacizumab (Avastin).
  • Ranibizumab (Lucentis).
  • Aflibercept (Eylea).
  • Brolucizumab (Beovu).
  • Faricimab-svoa (Vabysmo).

An eye doctor inject these medications in the affected eye. The shots may be needed every 4 to 6 weeks to maintain the beneficial effect of the medicine. In some cases, vision can be partially recovered as the blood vessels and reduce the body absorbs the fluid under the retina.

The potential risks of these photos include:

  • Conjunctival hemorrhage.
  • Increased pressure in the eye.
  • Infection.
  • The detachment of the retina.
  • Inflammation of the eyes.

Therapies

  • Photodynamic therapy.This procedure is a possible treatment for the irregular blood vessel growth in wet macular degeneration. However, it is much less common than the treatment with anti-VEGF shots. During photodynamic therapy, an eye, a doctor injected a drug called verteporfin (Visudyne) into a vein in the arm. Medicine, then, travels to the blood vessels in the eye. An eye doctor shines a light focused from a special laser on the affected blood vessels in the eye. This active verteporfin, causing the blood vessels to close. This stops the leak. Photodynamic therapy can improve vision and reduce the rate of vision loss. Multiple treatments may be required over time, as the treaty of blood vessels can be re-opened. After photodynamic therapy, it may be necessary to avoid the direct light of the sun and the bright lights until the medicine has cleared the body. This can take a couple of days.
  • The photocoagulation.During the photocoagulation treatment, an eye doctor uses a high-energy laser beam to seal problem blood vessels under the macula. This procedure helps prevent the vessels from bleeding, with the objective to minimize further damage to the macula. Even with this treatment, the blood vessels may grow back, that require additional treatment. The laser can also cause scarring, which creates a blind spot. Some people who have wet macular degeneration to obtain this treatment. It is not usually an option if you have a problem with blood vessels directly under the center of the macula. Also, the more damaged the macula is, the lower is the probability of success.
  • Low-vision rehabilitation. Age-related macular degeneration does not affect side vision, and usually do not cause total blindness. But you can reduce or eliminate the central vision. You need central vision to read, drive and recognize faces of people. You can help get the attention of a specialist in rehabilitation of low vision therapist, occupational therapist, a doctor of the eyes and other persons trained in low vision rehabilitation. They can help you find ways to adapt to the changes of the vision.

Photodynamic therapy. This procedure is a possible treatment for the irregular blood vessel growth in wet macular degeneration. However, it is much less common than the treatment with anti-VEGF shots.

During photodynamic therapy, an eye, a doctor injected a drug called verteporfin (Visudyne) into a vein in the arm. Medicine, then, travels to the blood vessels in the eye. An eye doctor shines a light focused from a special laser on the affected blood vessels in the eye. This active verteporfin, causing the blood vessels to close. This stops the leak.

Photodynamic therapy can improve vision and reduce the rate of vision loss. Multiple treatments may be required over time, as the treaty of blood vessels can be re-opened.

After photodynamic therapy, it may be necessary to avoid the direct light of the sun and the bright lights until the medicine has cleared the body. This can take a couple of days.

The photocoagulation. During the photocoagulation treatment, an eye doctor uses a high-energy laser beam to seal problem blood vessels under the macula. This procedure helps prevent the vessels from bleeding, with the objective to minimize further damage to the macula. Even with this treatment, the blood vessels may grow back, that require additional treatment. The laser can also cause scarring, which creates a blind spot.

Some people who have wet macular degeneration to obtain this treatment. It is not usually an option if you have a problem with blood vessels directly under the center of the macula. Also, the more damaged the macula is, the lower is the probability of success.

Lifestyle and home remedies

Even after receiving a diagnosis of wet macular degeneration, you can take some measures that can help to slow the loss of vision.

  • Do not smoke. If you smoke, talk with a health care professional to help you stop smoking.
  • Choose a healthy diet.Antioxidant vitamins in fruits and vegetables contribute to the health of the eyes. Kale, spinach, broccoli, squash, and other vegetables have high levels of antioxidants, including lutein and zeaxanthin. These nutrients may benefit people with macular degeneration. Eating foods with high levels of zinc may also be helpful for people with macular degeneration. These include protein-rich foods, such as beef, pork and lamb. Non-meat sources include milk, cheese, yogurt, whole grain cereals and whole wheat bread. Another good option is healthy unsaturated fats, such as olive oil. And research studies have shown that a diet high in omega-3 fatty acids, such as salmon, tuna and walnuts, may reduce the risk of advanced macular degeneration. But the same benefit is not shown taking omega-3 supplements, such as fish oil pills.
  • Manage your other medical conditions. If you have a cardiovascular disease or high blood pressure, for example, take the medication and follow your health care team instructions for the control of the condition.
  • Maintain a healthy weight, and exercising regularly. If you need to lose weight, reduce the number of calories you eat and increase the amount of exercise each day.
  • Have routine eye exams. Ask your eye doctor about the recommended schedule for follow-up examinations. Between tests, you can do a self-assessment of your vision using an Amsler grid.

Choose a healthy diet. Antioxidant vitamins in fruits and vegetables contribute to the health of the eyes. Kale, spinach, broccoli, squash, and other vegetables have high levels of antioxidants, including lutein and zeaxanthin. These nutrients may benefit people with macular degeneration.

Eating foods with high levels of zinc may also be helpful for people with macular degeneration. These include protein-rich foods, such as beef, pork and lamb. Non-meat sources include milk, cheese, yogurt, whole grain cereals and whole wheat bread.

Another good option is healthy unsaturated fats, such as olive oil. And research studies have shown that a diet high in omega-3 fatty acids, such as salmon, tuna and walnuts, may reduce the risk of advanced macular degeneration. But the same benefit is not shown taking omega-3 supplements, such as fish oil pills.

Supplements of vitamins

For people with an intermediate level or advanced the disease, taking a high-dose formulation of antioxidant vitamins and minerals may help reduce the risk of vision loss. The investigation of the Age-related Eye Disease Study 2 (AREDS2) has shown benefit in a formulation that includes:

  • 500 milligrams (mg) of vitamin C.
  • 400 international units (IU) of vitamin E.
  • 10 mg of lutein.
  • 2 mg of zeaxanthin.
  • 80 mg of zinc, oxide of zinc.
  • 2 mg of copper as cupric oxide.

Ask your eye doctor if taking supplements is right for you.

Coping and support

Vision loss due to macular degeneration can affect the ability to do things such as reading, recognizing faces, and the drive. These tips can help you deal with the change of vision:

  • Get your glasses prescription checked. If you wear contact lenses or glasses, make sure your prescription is up to date. If the new glasses don't help, ask for a referral to a specialist in low vision.
  • The use of magnifiers.A variety of magnifying devices can help you with the reading and in the other, to the work, such as sewing. Such devices include handheld magnifying glasses or lenses that you wear like glasses. You can also use closed-circuit television system that uses a video camera to extend the range of reading material, and projected on a video screen.
  • Change the screen of the computer and add audio systems. Adjust the font size in the configuration of the computer. And adjust the monitor to show more contrast. You can also add speech-output systems or other technologies, to your computer.
  • The use of electronic reading aids and voice interfaces. Try large-print books, tablet computers and audiobooks. Some of tablet and smartphone apps are designed to help people with low vision. And many of these devices now come with voice recognition features.
  • Select special equipment made for low vision. Some clocks, radios, phones, and other devices in very large numbers. You may find that it is easier to watch a television program with a large high-definition screen, or you may want to sit closer to the screen.
  • The use of bright lights in your home. Best lighting helps with reading and other activities of daily living, and may reduce the risk of falls.
  • Consider your transportation options. If you are driving a vehicle, check with your doctor to see if it is safe to continue doing so. Take special care in certain situations, such as driving at night, in heavy traffic or in adverse weather conditions. Use public transportation, or ask a friend or family member to help, especially with night driving. Or use local van or transport services, volunteer management networks, or ride-sharing.
  • Get support. Have macular degeneration can be hard, and you may need to make changes in your life. You can go through many emotions as you adjust. Consider talking with a counselor or joining a support group. Spend time with supportive family members and friends.

The use of magnifiers. A variety of magnifying devices can help you with the reading and in the other, to the work, such as sewing. Such devices include handheld magnifying glasses or lenses that you wear like glasses.

You can also use closed-circuit television system that uses a video camera to extend the range of reading material, and projected on a video screen.

Preparing for your appointment

It is likely that you will need a dilated eye exam to check for macular degeneration. Make an appointment with a doctor who specializes in the care of the eyes, such as an optometrist or an ophthalmologist. An ophthalmologist can perform a complete examination of the eyes.

What you can do

Before your appointment:

  • When you make the appointment, ask if you need to do anything to prepare.
  • List of the symptoms that you are experiencing, including any that seem unrelated to your problem of vision.
  • List of all the medicines, vitamins, and supplements you are taking, including the dosage.
  • Ask a family member or friend to go with you. Have the pupils dilated by the examination of the eyes will affect your vision for a while after that, so you may need someone to drive or be with you after your appointment.
  • List of questions to ask your eye care professional.

For macular degeneration, questions include:

  • I have a dry or wet macular degeneration?
  • How advanced is my macular degeneration?
  • Is it safe for my car?
  • I experience the loss of vision?
  • Can my condition be treated?
  • It's going to take a vitamin or mineral supplement to help prevent the loss of vision?
  • What is the best way to control my vision for the changes?
  • What changes in my symptoms should I call you?
  • What are low vision aids can be useful to me?
  • What lifestyle changes can I do to protect my vision?

What to expect from your doctor

Your eye doctor is likely to ask you some questions, such as:

  • When did you first notice your vision problem?
  • How the condition affects one or both eyes?
  • Do you have trouble seeing things up close, at a distance, or both?
  • Do you smoke or do not use it to quit smoking? If so, how much?
  • What types of foods you eat?
  • Do you have other medical conditions, such as high cholesterol, high blood pressure or diabetes?
  • Do you have a family history of macular degeneration?
Symptoms and treatment of Wet macular degeneration