Diagnosis and Treatment Options for Wet Macular Degeneration

An Overview of Eye Anatomy

Wet AMD specifically affects the macula, a small but crucial area located in the center of the retina at the back of the eye. Although it takes up only a small portion of the retina, the macula is responsible for detailed central vision. You depend on it for everyday tasks that require clarity and precision, such as reading, driving, recognizing faces, and seeing objects clearly straight ahead.

The macula is densely packed with photoreceptor cells that sense light and color and allow you to see fine details. When light enters the eye, it is focused onto the retina and the macula. The photoreceptors convert this light into electrical signals, which travel through the optic nerve to the brain. There, these signals are processed into the images you perceive. When the macula is damaged by conditions like wet AMD, this visual pathway is disrupted and the center of your vision may become blurred, distorted, or dark.

What is Wet Macular Degeneration?

Wet macular degeneration, also called neovascular age-related macular degeneration, is a long-term eye condition that can cause blurry central vision or a central blind spot. It is one of the two main forms of AMD, the other being dry macular degeneration. Wet AMD develops when new, fragile blood vessels grow beneath the retina and macula. These abnormal vessels are prone to leaking fluid or blood, which can cause the macula to swell, lift, or scar. As the damage progresses, central vision can decline quickly, making it more difficult to read, drive, recognize faces, or perform detailed visual tasks.

Dry AMD, the more common type, involves gradual thinning and aging of the macula along with the buildup of yellow deposits under the retina. It typically progresses more slowly and causes more gradual changes in vision. Wet AMD, on the other hand, can appear more suddenly and lead to greater vision loss over a shorter time. Because dry AMD can convert to wet AMD, regular eye exams and monitoring are especially important if you have already been told you have macular changes.

Although wet AMD represents a smaller portion of overall AMD cases, it is responsible for most of the severe vision loss related to macular degeneration. The condition primarily affects older adults and is most often diagnosed in people over the age of 50.

What are the Symptoms of Wet Macular Degeneration?

Early signs of wet macular degeneration can be subtle, and some people initially assume they are simply normal age-related changes. Paying attention to your vision and seeking care early can make a real difference in protecting your sight. Common symptoms include:

• Distorted Vision

• Blurred Central Vision

• Dark or Empty Areas in Vision

As wet AMD advances, these symptoms often become more noticeable. People may experience faster vision loss, colors that appear faded or washed out, and growing difficulty with everyday tasks such as reading, driving, or recognizing people across a room. Because wet AMD can worsen quickly, any sudden change in central vision should be evaluated by a Nationwide Vision eye doctor as soon as possible. Early diagnosis and treatment provide the best opportunity to preserve the vision you still have.

Potential Causes of Wet AMD

Understanding what contributes to macular degeneration can make it easier to catch changes early and make informed choices about risk. While the exact cause of wet AMD is not fully understood, research suggests that a combination of genetic influences, lifestyle habits, and overall health factors can increase the likelihood of developing this condition.

Genetics

Family history plays a meaningful role in age-related macular degeneration. If a parent, sibling, or other close relative has been diagnosed with AMD, your own risk is higher than average. Certain inherited changes in genes, including those tied to the body’s immune and complement systems, have been linked to a greater chance of developing AMD. You cannot change your genes, but knowing your family history helps your Nationwide Vision provider decide how closely your eyes should be monitored over time.

Environmental and Lifestyle Factors

1. Smoking: Smoking is one of the most significant controllable risk factors for advanced AMD. It decreases blood flow to the retina and increases oxidative stress, which can damage delicate macular tissue. Quitting smoking, at any age, is one of the most powerful steps you can take to help protect your vision.

2. Diet: Diets that are low in antioxidants and omega-3 fatty acids may raise the risk of AMD. Choosing more leafy green vegetables, colorful fruits, and fish can provide nutrients that support the retina and help guard the macula against oxidative damage.

3. Sun Exposure: Long-term exposure to ultraviolet (UV) light can contribute to retinal stress. Wearing sunglasses that block UVA and UVB rays, along with a brimmed hat outdoors, adds an extra layer of protection for your eyes.

Age-Related Factors

Age is the strongest overall risk factor for wet macular degeneration. The condition is most common after age 50, and the likelihood increases with each passing decade. Some age-related changes in the macula are expected, but in certain individuals those changes progress more quickly and can lead to AMD. As you get older, regular comprehensive eye exams become increasingly important so that subtle changes can be identified and followed over time.

Additional Health Conditions

Some medical conditions are also associated with a higher risk of wet AMD, including:

• High Blood Pressure (Hypertension): Elevated blood pressure can damage the delicate blood vessels in the retina, increasing the likelihood of abnormal vessel growth in the macula.

• High Cholesterol: Excess cholesterol can contribute to deposits in blood vessels and may affect circulation to the retina.

• Cardiovascular Disease: Heart and blood vessel conditions can impact blood flow throughout the body, including the retina, and may raise the risk of macular degeneration.

Working closely with your primary care provider to manage these conditions, take medications as directed, and maintain a heart-healthy lifestyle can support both overall wellness and long-term eye health.

How is Wet Macular Degeneration Diagnosed?

Wet macular degeneration is typically identified through a comprehensive, dilated eye exam with additional imaging tests as needed. These evaluations allow your Nationwide Vision doctor to look for fluid, bleeding, and abnormal blood vessels beneath the macula. Because wet AMD can progress quickly, it is important to schedule an eye exam promptly if you notice new distortion, a dark spot, or any sudden change in your central vision.

A wet AMD evaluation often includes:

• Vision Testing: Checks how clearly you see letters and how your central vision is functioning.

• Dilated Retinal Exam: Dilating drops widen the pupil so the doctor can examine the retina and macula for signs of macular degeneration and related changes.

• Optical Coherence Tomography (OCT): A quick, painless scan that helps detect swelling or fluid under or within the retina.

• Retinal Imaging: Documents the appearance of the retina to track changes over time.

• Fluorescein Angiography (When Needed): Uses a dye and a special camera to help identify abnormal blood vessels and leakage patterns. Not everyone needs this test; your eye doctor will recommend it based on your symptoms and OCT findings.

Treatment Options for Wet AMD

Although wet macular degeneration cannot be cured, several effective treatments can slow the disease and, in some cases, improve vision. The primary goals of treatment are to limit leakage from abnormal blood vessels, protect the macula from further damage, and help you maintain as much central vision and independence as possible.

Anti-VEGF Injections

Anti–vascular endothelial growth factor (VEGF) injections are the main treatment for most people with wet AMD. VEGF is a protein that stimulates new blood vessel growth. In wet AMD, excess VEGF encourages fragile, leaky vessels to develop beneath the macula. Anti-VEGF medications block this signal, which can reduce leakage, bleeding, and swelling, and often stabilize or even improve central vision.

Many patients are surprised by how quickly an injection visit is completed. Typically:

• The eye is numbed with anesthetic drops (and sometimes a numbing gel).

• The surface of the eye is cleaned to lower the risk of infection.

• The medication is gently injected into the eye in just a few seconds.

• Vision may be temporarily blurry afterward, and mild irritation or a scratchy feeling is common for a day or two.

Photodynamic Therapy

Photodynamic therapy (PDT) is a two-step treatment that combines a light-sensitive medication with a special laser. The medication is injected into a vein and circulates throughout the body. Once it reaches the abnormal blood vessels in the eye, a low-power laser is used to activate the drug. This process helps close off the abnormal vessels while limiting damage to surrounding retinal tissue.

PDT is used less frequently today than anti-VEGF injections but can be helpful in specific cases, such as certain patterns of abnormal blood vessels or when additional therapy is needed alongside injections. It is usually performed as an outpatient procedure. Because the medication is activated by light, patients are often advised to avoid bright sunlight or intense indoor lighting for a period of time after treatment.

Laser Surgery

Laser surgery, sometimes called laser photocoagulation, uses a focused beam of light to seal abnormal blood vessels and stop them from leaking. This option is considered only when the problematic vessels are located away from the very center of the macula. Treating vessels directly beneath the central macula with a traditional laser could harm the area needed for sharp central vision, which is why this approach is now used more selectively and less often than injections.

The procedure is typically done in an office or outpatient setting. Numbing drops are placed in the eye, and the laser is applied in brief pulses to the targeted area. Follow-up visits and imaging allow your doctor to confirm whether leakage has stopped and to monitor for any signs that new abnormal vessels are forming.

Lifestyle Changes and Supportive Therapies

Medical treatments are only one part of managing wet AMD. Everyday habits and supportive tools can also play a meaningful role in protecting vision and maintaining independence:

• Eating a diet rich in leafy greens, brightly colored fruits, and fish to support overall eye health

• Exercising regularly and maintaining a healthy weight to support good circulation

• Quitting smoking to reduce further damage to the retina

• Using low-vision aids such as magnifiers, special reading lenses, and electronic devices to make daily tasks easier

For some patients with age-related macular degeneration, AREDS2-based vitamin supplements may be recommended to support macular health. Your Nationwide Vision doctor will review your diagnosis, stage of disease, and overall health to determine whether these supplements are appropriate for you.