Wet AMD Treatment
Long-term treatments for late-stage damage remain a research priority
Medically reviewed by Christine L. Larsen, MD
Wet AMD (age-related macular degeneration) is an eye disease that affects your central vision. Also called neovascular AMD, it occurs with the growth of new blood vessels that damage your macula. This is the part of your retina that controls what you see straight in front of you.
While there is no cure for AMD, treatments can help slow or reduce the vision loss that occurs with this disease. The main option involves the use of special drugs injected into your eye. Some types of wet AMD improve when these drugs are combined with laser therapy.
Treatments must be given on an ongoing basis, about every four to six weeks. This can be a barrier to continued care and optimal results. Side effects and eye damage can occur, though these problems are rare.
This article describes wet AMD treatments and the ways they can help your vision. It also explains possible side effects and other ways to offset the vision loss caused by wet AMD.
Dejan_Dundjerski / Getty Images
Wet AMD vs. Dry AMD
Age-related macular degeneration is an eye disease that causes damage to your macula, resulting in blurred central vision.
Dry AMD occurs when cells from your macula begin to thin and break down. It can exist in its early stages without symptoms. This allows for the buildup of drusen, small pieces of cellular debris that can cause gradual loss of central vision.
Wet AMD is called "wet" because it is linked to the growth of leaky blood vessels. It always begins as dry AMD. While vision loss from dry AMD can occur over years, wet AMD can cause sudden and dramatic central vision loss over days or weeks.
Wet AMD Treatment Options
Vision loss from wet AMD occurs when new abnormal blood vessels grow into your retina and leak fluid into this area. This causes vision distortion and gray areas in your central vision. Without prompt treatment, often within a few days to weeks of the start of symptoms, vision loss can become permanent.
The following wet AMD treatment options exist:
Anti-Vascular Endothelial Growth Factor (Anti-VEGF) Injections
Anti-VEGF injections help stop the growth of new, abnormal blood vessels that occur in wet macular degeneration. These treatments are regarded as first-line therapy for treating and stabilizing the condition.
Anti-VEGF drugs target VEGF, a molecule that supports new blood vessel growth. However, blood vessels that form behind your retina can leak blood and proteins that damage macular cells. Anti-VEGF drugs prevent the growth of these damaging new blood vessels.
Anti-VEGF drugs are administered as intravitreal injections into the vitreous cavity (the space directly behind your eye). These injections are repeated roughly every four to six weeks, based on the drugs used and the severity of your condition.
Anti-VEGF medications include the following:
Avastin (bevacizumab)
Beovu (brolucizumab)
Lucentis (ranibizumab)
Vabysmo (faricimab-svoa)
Susvimo (ranibizumab)
The procedure used to give an anti-VEGF treatment involves these steps:
Your eyes are cleaned to reduce the risk of infection.
The targeted eye(s) is numbed with eye drops to reduce pain.
A small device is used to keep your eyelids open and out of the way.
An injection is given into the white part of your eye using a very thin needle.
The injection process only lasts a few seconds.
Photodynamic Therapy
Though most people with wet AMD receive anti-VEGF injections as their sole treatment, some types of wet AMD may improve when these injections are combined with photodynamic therapy.
Photodynamic therapy uses a photosensitizing drug called verteporfin. The drug is injected into your arm and travels through your bloodstream to your eye. Your ophthalmologist activates the drug by shining a laser beam into your eye. When activated, the drug works to break down the abnormal blood vessels causing vision loss.
Depending on your response to this treatment, you may need photodynamic therapy repeated at three-month intervals.
Laser Photocoagulation
Laser photocoagulation may be used to treat specific rare types of wet AMD in which abnormal blood vessels are not beneath the center of your macula. This treatment is a type of minimally invasive surgery that uses thermal laser treatments to seal or destroy leaky blood vessels.
Since it can also damage the vision cells overlying the blood vessels, laser photocoagulation is reserved for abnormal blood vessels that develop far from the macula's center.
Learn More: Managing Age-Related Macular Degeneration (AMD) Vision Loss
Do Wet AMD Treatments Restore Vision Loss?
There are no guarantees regarding the results of wet AMD treatments. Your outcomes are heavily affected by how early you begin treatment and the type of wet AMD that occurs.
Anti-VEGF treatments are most effective in slowing vision loss by stopping bleeding and leaking from abnormal blood vessels that form on your retina.
For some people, lost vision is restored when the leakage from abnormal blood vessels dries up and the retina is restored to its normal condition.
According to the American Academy of Ophthalmology, about 30% of people treated with anti-VEGF injections experience improved vision. At a minimum, this treatment stabilizes vision in 90% of those who receive it.
Learn More: Macular Degeneration: Timeline of Vision Loss Progression
Wet AMD Treatment Side Effects
Wet AMD treatment side effects can vary by therapy and your individual characteristics. Factors such as chronic conditions and certain medications may trigger side effects.
To reduce your risk of side effects and complications, ensure that your ophthalmologist has a complete medical history and list of your current medications.
Anti-VEGF treatments
Common side effects of an anti-VEGF treatment typically occur as a result of the injection rather than the drug. These problems can include the following:
Feeling of grittiness, soreness, aching, or discomfort for a couple of days
Small eye floaters or blobs in your field of vision for a few days
Transient flashing lights or swirls of light right after the injection
Redness or bleeding on your conjunctiva (the white part of your eye) at the entry point of the needle
Major complications are rare with anti-VEGF treatment. If they occur, they can involve the following:
Serious eye infection
Increase in eye pressure
Bleeding and blood clots in your eye
Photodynamic Therapy
The long-term effects and consequences of photodynamic therapy are still being studied. A severe loss in visual clarity can occur with photodynamic therapy though vision partially recovers in some people.
Treatment with photodynamic therapy can also result in the following side effects:
Temporary visual disturbances (decreased or abnormal vision or defects in your visual field)
Pain, swelling, bleeding, or inflammation at the site where the verteporfin is injected
Low back pain related to the injection of the medicine
Photosensitivity reactions such as sunburn
Laser Photocoagulation
Each pulse of the laser used in laser photocoagulation causes a microscopic burn in your retina. As a result of this process, potential side effects include the following:
Mild loss of vision
Reduced night vision
Blind spots
Diminished peripheral (side) vision
Blurred vision
Difficulty focusing
Reduced color vision
Other Ways to Slow Wet AMD Progression
While anti-VEGF injections are regarded as the most effective treatment to slow wet AMD progression, you can take other steps to support your eye health and manage vision changes.
Lifestyle Modifications
Making the following lifestyle modifications may help reduce your risk of disease progression:
Exercise regularly.
Eat a Mediterranean-style diet, a healthy diet that includes fish, leafy green vegetables, fruits, vegetables, and food rich in vitamin A, vitamin C, vitamin E, antioxidants, zinc, copper, and omega-3 fatty acids.
Manage chronic conditions like obesity, high blood pressure (hypertension), and atherosclerosis (hardening of the arteries caused by a buildup of plaque in the inner lining).
Continue self-assessment using an Amsler grid at home to track the progression of your vision changes.
Schedule regular eye exams every six months or shorter, as advised by your ophthalmologist.
Request an urgent consultation with your ophthalmologist at the first sign of a sudden vision change to avoid a delay in treatment.
Nutritional Supplements
Results from two major clinical trials—the Age-Related Eye Disease Studies (AREDS) and AREDS2—have demonstrated that the following combination of vitamin supplements may help delay the progression of dry AMD to wet AMD:
Vitamin C: 500 milligrams (mg)
Vitamin E: 400 international units (IU)
Copper (cupric oxide): 2 mg
Zinc: 80 mg
Lutein: 10 mg
Zeaxanthin: 2 mg
While these vitamins can't improve wet AMD, they may help if your disease hasn't progressed at the same rate in both eyes. This may be the case if one eye has intermediate-stage dry AMD and the other has wet AMD. Taking the vitamins may help slow the transition from dry AMD to wet AMD in the healthy eye.
Low-Vision Devices and Vision Rehab
Low-vision devices can improve your quality of life if your vision interferes with your ability to perform visual activities.
Low-vision rehabilitation can help you identify and learn to use magnifying optical devices and lighting aids that can help you perform specific vision functions.
Low-vision devices can include the following:
Eyeglasses with high-powered lenses to maximize your remaining vision
Large-print reading materials
Phones and clock faces with large numbers
Closed-circuit television magnifier
Handheld and desktop magnifiers
Telescopic devices that bring objects such as writing on a blackboard, visually closer
Reading devices that convert written text into read-aloud speech
Computer software to magnify the screen or convert text into speech
Risk Factors That May Predispose You to Rapid Disease Progression
The following factors increase your risk of rapid progression to wet AMD:
Age, with higher risk beginning around the ages of 55–64 and increasing with age
Smoking
Family history of early-onset and severe AMD
Prior stroke or heart attack
Consuming a diet high in saturated fat
Treatment Advancements for Wet AMD
The introduction of anti-VEGF injections was a groundbreaking advancement in the treatment of people suffering from vision loss from wet AMD. The injections offered hope that the condition could be slowed and potentially stopped or even reversed.
New treatment advancements explore alternatives to the need for indefinite monthly injections. The hope is that new therapies can be more convenient and enable more people to maintain more of their vision. These treatment advances include the following:
Gene Therapy
The goal of gene therapy is to provide a one-time treatment for wet AMD that helps your eye make its own anti-VEGF treatment. Of the current methods under investigation, one involves the injection of treatments under your retina in a surgical procedure. The other injects the treatment into your eye.
Port Delivery System (PDS)
The port delivery system uses a device smaller than a grain of rice to store anti-VEGF medication. It is implanted into your eye during a surgical procedure. When in place, it provides a continuous release of anti-VEGF drugs into your eye for up to two years.
Treatments Targeting Multiple Causes of Wet AMD
The Food and Drug Administration (FDA)–approved drug Vabysmo targets wet AMD and diabetic macular edema. Research indicates that treatment intervals may be extended for as long as four months.
Injection Alternatives
Research into the use of injection alternatives may enable people to eliminate the need for frequent and inconvenient eye injections. These alternatives include eyedrops and oral tablets.
Summary
Anti-VEGF injections are first-line treatments for wet AMD. These drugs slow vision loss by stopping the bleeding and leakage from abnormal blood vessels. Though not common, they may be combined with laser therapies.
Anti-VEGF treatments are effective and can even reverse vision loss. However, these injections must be given monthly for the long term. The inconvenience can often pose a barrier to continued care and the best outcomes.
New and emerging therapies may offer ways to extend the time between treatments. This may make it easier for more people to follow through on their prescribed treatment.
You can improve your results with current wet AMD treatments by catching the disease early and starting treatments as soon as possible. Delays in treatment have been linked with vision loss.
Read the original article on Verywell Health.
