Wet macular degeneration
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Wet macular degeneration is one of the two main forms of age-related macular degeneration (AMD). It occurs when blood vessels start to leak fluid or blood into the macula. Wet macular degeneration is a persistent eye condition characterized by blurred vision or the development of a blind spot in the central field of vision.
The macula plays a crucial role in providing clear vision in the direct line of sight. With AMD, the central vision becomes compromised, but peripheral vision remains unaffected, which means that total blindness does not typically result from this condition.
Early intervention can potentially restore vision in certain cases, making early detection and treatment essential in managing this condition and minimizing vision loss.
Symptoms
People with wet macular degeneration may notice a sudden onset of symptoms such as distorted or blurred central vision, and these symptoms tend to progress rapidly.
Common symptoms of wet macular degeneration include:
- Decreased central vision in one or both eyes
- Visual distortions, such as the apparent bending of straight lines.
- Presence of a well- definedblurry or blind spot within the visual field
- Increased blurriness in printed text
- Challenges adapting to low-light environments
- Requirement of increased lighting for reading or close-up tasks
- Trouble recognizing faces
If any of the signs and symptoms are experienced, consult a healthcare provider for proper diagnosis and treatment. Any observed changes in the central vision. Your capacity to perceive fine details diminishes. The loss of fine detail vision can be an early indicator of macular degeneration, particularly in individuals aged 60 and older.
Regular eye examinations are also essential for detecting and addressing vision changes.
Causes
Age-related macular degeneration (AMD) comes in two forms: wet macular degeneration and dry macular degeneration. Dry macular degeneration is the more common and less severe type. Interestingly, every case of wet macular degeneration initially begins as the dry type. Approximately 20% of individuals diagnosed with age-related macular degeneration eventually develop the wet variant.
Wet macular degeneration is a condition that develops in patients who initially have dry macular degeneration. Despite ongoing research, the exact cause of wet macular degeneration remains unknown.
There are various ways that wet macular degeneration might progress:
- Loss of vision due to fluid buildup in the back of the eye: Fluid that seeps from the choroid may gather inside the layers of the retina or between the retina and the thin layer of cells known as the retinal pigment epithelium. These abnormalities in the layers of the macula may cause vision loss or distortions.
- Loss of vision due to irregular blood vessel growth: Choroidal neovascularization is characterized by the abnormal development of new blood vessels originating from the choroid and extending into the macula. The function of the retina may be impacted by these blood vessels leaking blood or fluid. The choroid is a vascular layer between the retina and the sclera of the eye.
Risk factors
There are several risk factors for age-related macular degeneration, such as:
- Age: People who are 55 years and older are more susceptible to this condition.
- Race: White people are at a higher risk of macular degeneration.
- Family history and genetics: Researchers have pinpointed several specific genes associated with the condition. This suggests that individuals with a family history of macular degeneration may be more predisposed to developing the condition due to shared genetic factors.
- Being overweight: Early or intermediate macular degeneration, which may develop into a more advanced stage, are more likely to occur in people who are obese.
- Smoking: The likelihood of developing macular degeneration is higher among active smokers and those exposed to secondhand smoke.
- Underlying cardiovascular issues: An increased risk of developing macular degeneration is possible in individuals with conditions impacting their heart and blood vessels.
Diagnosis
The diagnosis of age-related macular degeneration typically entails several steps, including assessing the individual’s symptoms, reviewing their medical and family history, conducting a thorough eye examination, and performing various diagnostic tests.
Tests that may be ordered include:
- Examination of the back of the eye: This procedure checks for signs like fluid, blood, or a mottled appearance caused by yellow deposits that form under the retina called drusen, commonly found in people with macular degeneration. Prior to the examination, the eyes are dilated using eye drops. The back of the eye is then examined using a specialized tool.
- An examination to check for changes in the central vision: Using Amsler grid, alterations in the central vision is assessed. For individuals with macular degeneration, certain straight lines within the grid may appear faded, fragmented, or distorted.
- Fluorescein angiography: In this procedure, images are captured by a specialized camera while the dye passes through the blood vessels. The retinal alterations and any leaking blood vessels will be seen in the photographs. Prior to the procedure, the healthcare provider introduces a dye into a vein in the arm. The dye then circulates and accentuates the blood vessels in the eye.
- Indocyanine green angiography: This can be employed to verify the results of a fluorescein angiography or to pinpoint problematic blood vessels located deeper within the retina.
- Optical coherence tomography: This test can detect the regions of thinning, thickening, or swelling of the retina and is also utilized to track the retina’s response to treatments for macular degeneration. This non-invasive imaging examination shows finely detailed retinal cross sections.
- Optical coherence tomography (OCT) angiography: Although its utilization is increasing in clinical settings, it is originally employed more for research purposes. This is a modern, noninvasive examination that enables the healthcare provider to observe undesired blood vessels in the macula.
Treatment
Treatment options for wet macular degeneration range from medications to specialized procedures. There are treatment options available that can potentially slow the progression of the disease and maintain existing vision. If initiated in a timely manner, some lost vision may even be regained through treatment.
- Medications: Medications such as bevacizumab, ranibizumab, aflibercept, brolucizumab, and faricimab-svoa, are commonly used to inhibit the growth of new blood vessels in the treatment of all stages of wet macular degeneration.
- These medications, referred to as anti-VEGF drugs, function by inhibiting the signals that stimulate the body to create new blood vessels. They are administered through injections directly into the affected eye. In certain instances, there is potential for partial vision improvement as the blood vessels shrinkand the fluid beneath the retina gets reabsorbed.
Maintenance shots every 4 to 6 weeks are often necessary to sustain the positive effects of the medication. Conjunctival hemorrhage, increased eye pressure, infection, retinal detachment, and eye inflammation are among the potential adverse effects of usage. - Therapies
- Photodynamic therapy: During this procedure, a verteporfin injection is administered by into a vein in the arm, where it goes to the blood vessels in the eye. A specific laser is used to target the troublesome blood vessels, and this activates the verteporfin, leading to the closure of problematic blood vessels, effectively halting the leakage. Following photodynamic therapy, steer clear of direct sunlight and bright lights for a few days, until the medication has fully cleared the system.
Although this treatment may slow down the vision loss process and enhance vision, it may eventually require repeated treatment since the blood vessels that were repaired may reopen. This treatment is also not as commonly employed as anti-VEGF shots. - Photocoagulation: Photocoagulation therapy aims to stop bleeding in problematic blood vessels, minimizing additional damage to the macula. During the procedure, a high-energy laser beam is utilized to seal problematic blood vessels beneath the macula.
This therapy is not commonly administered to individuals with wet macular degeneration, especially if problem blood vessels are directly under the center of the macula. The success likelihood diminishes as the macula’s damage increases. The laser can cause scarring, resulting in a blind spot. There is also a possibility of blood vessels regrowing, necessitating further intervention. - Low vision rehabilitation: Age-related macular degeneration does not impact your peripheral vision and does not result in complete blindness. However, it can diminish or even entirely impair your central vision, which is vital for tasks such as reading, driving, and recognizing faces.Seeking assistance from healthcare specialists trained in low vision rehabilitation can be beneficial. These healthcare providers can give guidance on adapting to changes in vision and help find strategies to cope with the challenges posed by macular degeneration
- Photodynamic therapy: During this procedure, a verteporfin injection is administered by into a vein in the arm, where it goes to the blood vessels in the eye. A specific laser is used to target the troublesome blood vessels, and this activates the verteporfin, leading to the closure of problematic blood vessels, effectively halting the leakage. Following photodynamic therapy, steer clear of direct sunlight and bright lights for a few days, until the medication has fully cleared the system.
