Wet macular degeneration is a chronic eye condition impacting the macula, the central region of the retina. This ailment is characterized by the development of abnormal and fragile blood vessels that leak fluid or blood under the macula, the portion of the eye responsible for sharp, straight-ahead vision.
Often, dry macular degeneration can evolve into the more advanced and severe wet, or exudative, form.
The onset of exudative macular degeneration can cause swift visual changes and compromise central vision acuity.
Vision deterioration can significantly influence an individual’s lifestyle, hindering their ability to engage in beloved activities and diminishing their overall life satisfaction.
Therefore, individuals with AMD are encouraged to undergo routine, thorough eye examinations to preserve optimal ocular health.
This document delves into the details of wet macular degeneration, including its symptoms, etiology, diagnostic process, and available treatments.
What is exudative macular degeneration?
Wet AMD, a Primarily Aging-Related Eye Condition
Wet age-related macular degeneration (AMD) stands as a primary reason for vision impairment in individuals over the age of 55Trusted Source.
In those with AMD, a build-up of yellow deposits known as drusen accumulates beneath the retina, leading to the macula’s deterioration—the central part of the retina—responsible for detailed central vision.
This degenerative process also entails the degeneration of pigment epithelial cells (RPE) and the cells responsible for light perception.
The wet form of AMD is distinguished by the formation of new, but fragile blood vessels behind the macula. These vessels are prone to leakage, releasing fluid and blood that results in the macula’s scarring, causing quick and extensive visual damage.
The impairment of central vision might occur abruptly, on occasion, within a matter of days or weeks.
Exudative macular degeneration represents a serious progression of AMD that leads to a swift decline in visual acuity.
Though not as prevalent as its counterpart, the dry form, wet AMD constitutes about 10% of all AMD diagnoses, yet it is behind 90% of severe vision loss incidents.
Medical professionals can offer treatments targeted at mitigating blood vessel proliferation in wet AMD. It is also recommendedTrusted Source to adopt dietary supplements rich in antioxidant vitamins, zinc, and copper, based on an AREDS2 formula designed specifically for these cases.
Symptoms
Individuals often experience dry age-related macular degeneration (AMD) prior to advancing to wet, or exudative, AMD.
Initial signs of dry AMD can be mild, perhaps seen as a blurred area in the center of vision. This can intensify over time, leading to a heightened, darker blind spot, possibly culminating in a total loss of central vision.
As per the Bright Focus Foundation, it’s common for someone to have the early stages of dry AMD for an extended period before it escalates to exudative AMD.
Yet, when exudative AMD sets in, the central vision might deteriorate rapidly, potentially in mere days or weeks, due to bleeding from the newly formed blood vessels in the retina. These visual symptoms, though generally pain-free, can include:
- Alterations in vision that cause straight lines to appear wavy.
- A murky, red, or black spot obstructing the center of the visual field.
- Parts of words missing while reading.
- Challenges in distinguishing colors.
- Discomfort in bright lighting conditions.
Causes
The precise causes of exudative macular degeneration remain undetermined, though links to various factors have been established, including:
Age: Those over the age of 55 have an elevated riskTrusted Source of developing AMD.
Tobacco Use: Smoking heightens the risk, making smokers up to four times more susceptible to AMD than non-smokers.
Hypertension: High blood pressure can lead to narrowed retinal blood vessels, increasing the risk of AMD.
Hereditary Links: A person’s risk is increased if immediate family members have AMD.
Race: Studies indicateTrusted Source that older individuals of Caucasian ancestry are more prone to developing AMD compared to other ethnic groups.
Sex: Research suggestsTrusted Source women are at a higher risk of AMD than men.
Nutritional Factors: Diets high in fat, cholesterol, and high-glycemic index foods, combined with a low intake of leafy greens, can increase the risk of AMD.
The transition from dry to wet AMD in certain individuals is not fully understood. It has been hypothesized that the death of photoreceptor and RPE cells may prompt the abnormal blood vessel proliferation characteristic of wet AMD.
Diagnosis
Patients with dry age-related macular degeneration (AMD) should undergo routine, comprehensive examinations by an eye specialist to monitor their condition.
Those who experience a noticeable deterioration in vision or an abrupt visual shift should arrange for an evaluation by their ophthalmologist, which may include:
Fundus Autofluorescence. This imaging technique enables the physician to inspect the retina and assess whether the dry AMD is advancing.
Pupil Dilation Test. The ophthalmologist employs medicated drops to enlarge the pupils, thus allowing for a detailed inspection of the retina, the evaluation of optic nerve health, and the detection of drusen deposits.
Direct Ophthalmoscopy. Through this method, the eye expert examines the health of the retina, its blood vessels, and other significant structures at the back of the eye by directly observing them with a specialized instrument and light.
Optical coherence tomography (OCT). OCT is a non-intrusive, imaging procedure that crafts a detailed view of the retina’s various layers. It’s used to identify any retinal thinness, fluid accumulation, or presence of drusen and to monitor how well treatments are working.
Treatment
While there is no cure for age-related macular degeneration (AMD), various treatments can help to slow the progression of vision loss or prevent it altogether.
Anti-VEGF Therapy
For the management of AMD, medications known as angiogenesis inhibitors or anti-VEGF drugs are pivotal. They combat a protein named vascular endothelial growth factor (VEGF) that fosters the proliferation of new blood vessels.
To administer these drugs, an ophthalmologist will numb the eye and inject the medication into the vitreous, the eye’s gel-filled center. The frequency of these injections varies, dependent on the drug used, the state of the disease, and the patient’s response to treatment.
Though somewhat rare, potential side effects include blurry vision, inflammation, discharge, pain, or discomfort, as well as risks like cataract formation and intraocular bleeding.
The FDA has sanctioned several anti-VEGF drugs, including:
- Brolucizumab (Beovu)
- Aflibercept (Eylea)
- Ranibizumab (Lucentis)
- Pegaptanib sodium (Macugen)
Additionally, bevacizumab (Avastin), though initially FDA approved for colorectal and other cancers to inhibit vessel growth, is sometimes prescribed off-label for wet AMD, offering a significantly cheaper alternative to the aforementioned treatments.
Discover strategies to reduce prescription medicine costs here.
Photodynamic Therapy (PDT)
PDT stands as a Trusted Source endorsed option for treating a form of wet AMD known as predominantly classic subfoveal AMD, although anti-VGEF inhibitors are more commonly recommended.
In PDT, a medication named Visudyne is intravenously injected. It circulates through the bloodstream to the abnormal blood vessels in the eye. A low-powered laser then activates Visudyne for approximately a minute, allowing it to ablate the abnormal vessels.
Side effects are generally minor, involving headaches, minor reactions where injected, and temporary blurred vision.
Read about various types of medical injections here.
Laser Surgery
Laser photocoagulation is a feasible treatment for a limited group of AMD patients. By numbing the eye and applying a laser, the ophthalmologist seals off and eradicates the abnormal vessels within the eye.
Although this surgery aims to prevent further vision deterioration, it inevitably results in a permanent blind spot due to scarring.
Gene Therapy Potentials
Emerging treatments, including gene therapy, present promising prospects in the battle against wet AMD.
Summary
Exudative macular degeneration, also known as wet AMD, is an advanced stage of age-related macular degeneration, affecting around 10% of those with AMD. In this progression, new, abnormal blood vessels form behind the retina and can leak fluid or blood, leading to retinal scarring and a drastic reduction in central vision.
To manage wet AMD, treatments include intraocular injections, laser surgery, or photodynamic therapy. While these interventions don’t cure the condition, they aim to halt or decelerate vision deterioration.
Individuals with dry AMD experiencing any symptom exacerbation should promptly consult a healthcare provider.
