Age-related macular degeneration (AMD) causes your central vision to get worse as you get older. An estimated 19.6 million people over 40 live with AMD, and nearly 1.5 million of them have their vision threatened by the condition.
There are two forms of AMD: dry and wet. Both involve damage to the macula, or the part of the eye that helps you see what's right in front of you. Wet AMD is the rarer, more serious form of the condition. It happens when new blood vessels form in the back of your eye that leak fluid and damage your macula.
When it gets worse, wet AMD can cause blurred vision in the central part of your eyesight. While you’ll still be able to see from the sides of your eye, wet AMD may make it harder to do everyday tasks like driving, cooking, and reading.
There are a couple of types of treatments that can help slow or prevent vision loss from wet AMD: injected medications and laser procedures.
Injections and Implants for Wet Macular Degeneration
Shots to the eye are by far the most common way to treat wet AMD. They're the only type of wet AMD treatment most people get.
Eye injections may sound scary, but your doctor can make it so you don’t feel the procedure at all. Your doctor will put a numbing medicine into your eye. Then they’ll clean the area with an iodine solution to guard against infection. Finally, your doctor will use a very small needle to inject medicine into your eye.
These medicines belong to a class of drugs called anti-angiogenics, which work by stopping the growth of new blood vessels – in this case, those that threaten your macula. Injectable macular degeneration drugs block vascular endothelial growth factor (VEGF) protein, which is involved in creating new blood vessels. These medications can reduce vision loss and sometimes even improve vision.
Injectable anti-VEGF medications include:
- Aflibercept (Eylea)
- Bevacizumab (Avastin)
- Brolucizumab (Beovu)
- Ranibizumab (Lucentis)
Another type of injectable antiangiogenic medication, faricimab-svoa (Vabysmo), not only blocks VEGF but also stops another protein involved in forming blood vessels called angiopoietin-2 (Ang-2). People on this medication may be able to go longer between shots.
The FDA also recently approved ranibizumab in implant form (Susvimo). A doctor implants the device, about the size of a grain of rice, into your eye. They then refill it with medication about once every 6 months.
When you first start most types of injections, you'll probably get a shot about once a month. Later on, you may need follow-up shots less often. Some people may be able to stop getting them eventually.
You should be able to return to your normal activities shortly after getting the shot. To avoid infection, avoid getting your eyes wet (such as through swimming) for several days. Try not to touch or rub your eyes, and stay out of dusty places.
Benefits of anti-angiogenic injections for wet AMD. These treatments are very effective in preventing vision loss. For about 90% of people, vision will stop getting worse. About a third of those who get anti-angiogenic shots notice that their vision actually gets better.
Risks of anti-angiogenic injections for AMD. It's rare to have serious side effects from these treatments. For a few days, you might notice:
- Itchy, dry, red, or sore eyes
- Temporarily blurred vision
- The feeling that something is in your eye
You could get an air bubble in your eye from the injection that looks like a small black dot in your vision. It should clear up in a day or two. If it doesn’t, talk to your doctor.
Your doctor could accidentally hit the lens of your eye while giving you the shot. This can lead to a cataract, which clouds the clear lens of your eye.
If you have an autoimmune disease like lupus or rheumatoid arthritis, you might have inflammation in your eye after your injections.
Pressure may build up in your eye after your shot and cause your vision to dim. This usually goes away on its own. If not, your doctor will remove some of the fluid at the front of your eye to stabilize pressure.
Some serious, though uncommon, possible side effects of anti-angiogenic shots include:
- Intense sensitivity to light
- An infection inside your eye, which can cause blurry vision and pain
- Retinal detachment, which can cause you to see flashing lights, floating spots or lines, or a dark "curtain" that blocks part of your vision
If you notice any of these symptoms, call your doctor right away.
Photodynamic Therapy for Wet AMD
A less common treatment for wet AMD is photodynamic therapy, which uses a heat-free laser along with light-activated medication.
Your doctor injects the light-sensitive medication into your arm and waits for it to reach the blood vessels in your eye. They numb your eye and place a special contact lens onto it to guide the placement of the laser. Then, they flash light from the laser into your eye to activate the medication. It causes clots in the blood vessels at the back of your eye, sealing them off and preventing further damage.
You'll probably need 2-5 treatments, 3-4 months apart. Since the treatment makes your eyes and skin more sensitive to sun, you'll need to avoid it for several days after each treatment.
Benefits of photodynamic therapy for wet AMD. This treatment is used less often now that the more effective and safer anti-angiogenic medications are available. But your doctor may recommend that you get it along with the medications. Or you could get it instead of the anti-angiogenic drugs if they don't work for you.
This therapy doesn't restore lost vision, but it can slow down vision loss.
Risks of photodynamic therapy for wet AMD. This type of therapy can be used only for people with wet AMD whose vision loss has happened slowly. It doesn't work for everyone.
Possible side effects include:
- Pain where your doctor injected the medicine
- Sunburn due to increased sun sensitivity
- A new blind spot in your eye
- A temporary loss of sharpness in your vision. In rare cases, this can be permanent.
Photocoagulation Therapy for Wet AMD
A few people with wet AMD may be candidates for an older type of laser treatment called photocoagulation therapy. You might hear this called "hot" laser surgery. This procedure works much like photodynamic therapy, except the laser itself seals the leaky blood vessels.
Your doctor first gives your drops to numb your eye. They insert a contact lens to help the laser focus. Then, they use an intense laser beam to burn blood vessels under your macula. This stops them from leaking blood and fluid.
Benefits of photocoagulation therapy for wet AMD. The procedure may be able to prevent further vision loss, though it can't help you regain vision. If it's successful, you may only need it once. You can get it along with anti-angiogenic medications.
Risks of photocoagulation therapy for wet AMD. Laser surgery is riskier than anti-angiogenic medications. And this type is an option only for certain types of wet AMD. It's best for people whose abnormal blood vessels are grouped together, rather than scattered. It's not for those whose problem blood vessels are right under the center of the macula. And it probably won't help much if your macula is already very damaged.
Blood vessels can regrow after the surgery, which usually means you'll need further treatment. Scarring from the laser can result in a permanent blind spot. Sometimes, your vision can end up worse than it was before the surgery.
Ask your doctor about the benefits and risks of any treatments they recommend for wet AMD. They can help you decide on a treatment plan that's right for you.
Show Sources
Photo Credit: Westend61 / Getty Images
SOURCES:
CDC: “Prevalence of Age-Related Macular Degeneration (AMD).”
American Academy of Ophthalmology: “Macula,” “What Is Avastin?” "Anti-VEGF Treatments," "Two New Tools to Treat Wet AMD."
National Eye Institute: “Age-Related Macular Degeneration (AMD).”
Beatrice Brewington, MD, assistant professor, Department of Ophthalmology, University of North Carolina at Chapel Hill.
American Academy of Ophthalmology Eye Wiki: “Bevacizumab.”
Johns Hopkins Medicine: “Photodynamic Therapy for Age-Related Macular Degeneration,” "Laser Photocoagulation for Age-Related Macular Degeneration."
Saudi Journal of Medical and Pharmaceutical Sciences: “Exudative Age-Related Macular Degeneration: A Case Report and Review of the Literature.”
National Center for Biotechnical Information: “Photodynamic Therapy For The Eye.”
National Cancer Institute: “Cataract.”
Bright Focus Foundation: "Injections for Wet Macular Degeneration: What You Need to Know," "Treatments for Macular Degeneration."
Macular Society: "Treatments."
Mayo Clinic: "Wet Macular Degeneration.”
