Wet Macular Degeneration

What is wet macular degeneration?

Wet age-related macular degeneration (WMD) is the advanced form of age-related macular degeneration (ARMD), a condition that can cause permanent central vision loss. WMD is an advanced form of age-related macular degeneration. It happens when age-related changes in your eyes worsen and cause new blood vessels to grow and leak underneath the retina.

When you have WMD, new vessels grow and disrupt existing retinal tissue, causing damage and vision loss. The leaked blood can also cause scar tissue to form, further distorting and damaging the macula.

Over time, the leaked blood and scar tissue can cause permanent vision loss. However, early detection and treatment can prevent that kind of permanent damage or stop it from further damaging your vision. If you notice vision changes that could be WMD, you need to see an ophthalmologist as soon as possible.

The formal name for this condition is exudative (pronounced either “EX-yoo-dat-iv” or “EGS-yoo-dat-iv”) macular degeneration or neovascular macular degeneration. “Exudate” is a medical term for leaked fluid, which is where this condition’s formal name comes from.

How common is this condition?

Your odds of developing ARMD increase with age, and it’s the leading cause of vision loss for adults over 60. About 10% to 20% of ARMD cases are the wet form, meaning between 10 million and 20 million adults worldwide have WMD. Between 1 and 2 million of those cases are in the U.S.

What are the symptoms of wet macular degeneration?

Wet macular degeneration causes painless central vision loss. It can affect both eyes, though it may do so unevenly.

Symptoms can include:

• Dark spots or floaters.
• Blurry vision, especially up close.
• Fading or decreased color vision, including blue-yellow color deficiency.
• Distorted vision (metamorphopsia).
• Objects appearing smaller than they really are (micropsia).
• Darkened areas of vision.
• Blind spots (scotomas).
• Complete central vision loss (meaning you only have peripheral vision).

What causes wet macular degeneration?

WMD isn’t a condition with a single cause. Instead, it’s a condition where many risk factors or contributors can add up and make this condition more likely to develop.

The risk factors and contributors that can play a role in developing WMD include:

• Age. The older you get, the more likely you are to develop macular degeneration of any kind.
• Genetics and family history. The DNA you inherit from your biological parents can contain mutations or differences that make you more likely to develop WMD.
• Race. People with European ancestry have the highest risk of developing WMD. People of African descent are less likely to have WMD.
• Nutrition. Lack of certain vitamins (especially C and E), minerals (copper and zinc), and components of vitamin A or nutrients related to it (beta-carotene, lutein and zeaxanthin) can contribute to WMD.
• Geographic location. Living closer to Earth’s equator increases your overall light exposure, which can be a contributing factor.
• Habits. Tobacco use can contribute to developing WMD.
• Other health conditions. High cholesterol (hypercholesterolemia), high blood pressure (hypertension) and cardiovascular disease can all contribute to developing WMD. Diabetes (both Type 1 and Type 2) might also contribute, but available data is mixed on whether that’s the case.

What are the complications of this condition?

The main complication of wet macular degeneration is central vision loss. Without treatment, about 80% to 90% of people with WMD will eventually have vision loss severe enough that they meet the criteria for legal blindness.

How is wet macular degeneration diagnosed?

An eye care specialist, such as an ophthalmologist or a retina specialist, can diagnose WMD with a combination of methods.

The first step is a routine eye exam. During that exam, they can view your retinas directly. That’s possible either with a handheld instrument called an ophthalmoscope, or by dilating your pupils and doing a slit lamp exam. They may also use an Amsler grid eye test, a simple grid chart that makes it easier to see distortions in your vision (the distortions in your retina will distort the way the grid looks to you).

In addition to an eye exam and the slit lamp exam, an eye care specialist can also use noninvasive diagnostic imaging tests. These let your eye specialist look at the internal structures and blood vessels at the back of your eye. The possible tests include:

• Optical coherence tomography (OCT).
• Fluorescein angiography.
• Indocyanine green angiography (ICGA).

How is it treated?

Wet macular degeneration is very treatable if detected early enough. There are two main ways to treat WMD: medications and laser procedures.

Medication treatments involve blocking vascular endothelial growth factor (VEGF), a protein your body uses for growing new blood vessels. Blocking VEGF stops the formation of new blood vessels. The medications that can do this are given via an injection into your eye.

These medications include:

• Aflibercept.
• Bevacizumab.
• Brolucizumab.
• Faricimab.
• Ranibizumab.

The goal of laser procedures for WMD is to stop new blood vessels from growing and shrink them, if possible. Whether laser surgery is an option depends on where the new blood vessels are growing under your macula and other factors. Injections are more common than laser procedures.

Your eye care specialist is the best source of information about your treatment options. The information they give will be most relevant and helpful for your specific case. They can also tell you about the possible side effects or complications and which treatment will most likely help you.

Can wet macular degeneration be prevented?

There are so many contributing and risk factors for WMD that it’s impossible to prevent it entirely. But there are things you can do to reduce your risk of developing it or delay when it happens.

Some of the most important ways to prevent or delay WMD start when you have dry macular degeneration, the less-advanced form of ARMD. Steps your eye specialist could recommend include:

• Use an Amsler grid every day. Your eye specialist can give you an Amsler grid to use at home and guide you on how to use it. And if you see vision changes or distortions, you need to call your eye specialist as soon as possible. Doing that reduces your risk of having irreversible retinal damage and vision loss.
• See your eye specialist for regular vision checks. These can help with early detection of WMD.
• Take dietary supplements daily. These usually include vitamin C, vitamin E, copper, zinc, lutein, zeaxanthin and beta-carotene (you should avoid beta-carotene if you use tobacco, as it increases your risk of developing lung cancer).
• Quit tobacco use, or don’t start in the first place. This includes all kinds of tobacco/nicotine use, including vaping and smokeless tobacco. Your healthcare provider can give you resources to help you quit.
• Wear sunglasses. Sunlight exposure can increase your chances of developing WMD. Sunglasses reduce the impact of sunlight on your eyes.
• Stay active. Physical activity can help your health in many ways, including your retinal health.
• Reach and maintain a weight that’s healthy for you. Many of the contributing conditions that increase your risk of developing WMD have links to your overall physical health.

There may be other steps you can take to help yourself avoid vision loss from WMD. If you have any questions or concerns about steps you can take, ask your eye specialist. They can offer guidance and resources that can help you.

What’s the outlook for wet macular degeneration?

The outlook for WMD depends on several factors. They include:

• How advanced your WMD is.
• Where the damage is on your macula.
• Treatment options you can receive, or are receiving.
• Other health conditions you have.

Because so many factors can play a role, your outlook can vary widely. Your eye care specialist can tell you more about the likely outlook in your specific case.

How do I take care of myself if I have wet macular degeneration?

WMD can be very disruptive once it starts to cause vision loss. It can impact your ability to live independently and go about your usual routine and activities.

If you already have vision loss from WMD, there are still things you can do to help yourself. They include:

• Asking your eye care specialist about low vision rehabilitation. This is like physical or occupational therapy, but for your eyes. This kind of rehab teaches you how to adapt and work around any vision changes you already have.
• Using tools and technology. Low-tech items like magnifying glasses or lenses can make everyday tasks and activities easier. Higher-tech items, like smartphone apps or special electronic devices, can also help you work around your vision loss or changes. Your eye specialist can offer specific tips and information about which tools (high- or low-tech) you might benefit from.
• Take advantage of available resources and help. Depending on where you live, there may be government and independent organizations that can assist with your daily needs. Using them can help you live independently and make your life easier.

When should I see my eye specialist?

Your eye specialist will recommend a follow-up visit schedule to manage your WMD and adjust your treatments if necessary. These visits are a crucial part of limiting vision loss.

You should also call your eye specialist immediately if you notice changes in your vision, such as distortions you can see while testing your eyes with an Amsler grid.

What questions should I ask my eye specialist?

Some questions you may want to ask your eye specialist include:

• How severe is my WMD?
• What’s the likely timeline for vision loss, and what can I do to slow or limit the damage?
• Does the location of the macular changes affect the possible treatments or the odds that those treatments will be effective?
• How can I limit further damage?
• What resources and help are available to me?
• Would I benefit from vision rehabilitation therapy?

A note from Cleveland Clinic

Vision is a sense that most people use nearly constantly throughout their daily lives, often without thinking about it. Vision loss can be disruptive and upsetting. But there are things you can do to limit the damage, prevent further vision loss and adapt to any existing changes.

Talking to your eye care specialist is the best way to learn what you can do about this condition. They can guide you on steps and changes that can help you. They’re there to help you so you don’t have to face this condition or its effects alone.