Wet Macular Degeneration

Macular degeneration is an eye condition that can cause blurry or poor central vision. Normally, your vision is clear (like the picture on the left). But as macular degeneration progresses, the center of your vision can become blurry, and eventually, you may have a blind spot in the middle of what you see (like the picture on the right).

One type of macular degeneration is called "wet" macular degeneration. This happens when tiny blood vessels in the back of your eye leak fluid or blood. This leakage affects a part of the eye called the macula. The macula is like a special part of your retina that's crucial for seeing fine details clearly, especially things in the middle of your vision, like reading or recognizing faces.

Wet macular degeneration is one of two main types. The other type is "dry" macular degeneration. Dry macular degeneration is more common and usually less severe than wet macular degeneration. Importantly, wet macular degeneration always starts as dry macular degeneration.

Catching wet macular degeneration early and getting treatment is very important. Early treatment can sometimes help slow or even stop the vision loss. In some cases, early treatment can even help improve your vision.

Macular degeneration often comes on quickly and gets worse over time. Early signs can include:

• Distorted vision: Straight lines might look wavy or bent.
• Blurred or reduced central vision: You might have trouble seeing things clearly in the center of your field of vision, in one or both eyes. This can affect things like reading or recognizing faces.
• Needing more light: You might need brighter lights to read or do close-up work. This could also include having trouble seeing in low-light situations, like a dimly lit movie theater or restaurant.
• Blurred print: Printed words might look blurry or unclear.
• Trouble recognizing faces: You might have difficulty telling people apart, especially when you're looking directly at their faces.
• A blind or blurry spot: You might see a dark or blurry area in your central vision. This is often described as a "blind spot" or a "blurry spot." Crucially, macular degeneration doesn't affect your peripheral (side) vision, so you won't lose all your sight.

When to see your eye doctor:

If you notice any changes in your central vision, or have trouble seeing fine detail, especially if you're over 60, it's important to see your eye doctor. These changes could be early signs of macular degeneration. Don't delay, as early detection and treatment can help slow the progression of the condition.

Visit your eye doctor if you notice any changes in how clearly you see things in the middle of your field of vision. This includes trouble seeing small details. These problems could be an early sign of macular degeneration, especially if you are 60 or older. Macular degeneration is a condition that affects the part of your eye that's responsible for sharp, central vision.

The macula is a small, central part of the retina at the back of your eye. A healthy macula is essential for seeing things clearly in the center of your vision. It's packed with special light-sensitive cells called cones and rods. Cones help you see colors, and rods help you see shades of gray.

Wet macular degeneration is a type of vision loss that often develops after dry macular degeneration. Roughly 1 out of every 5 people with macular degeneration has the wet form. Scientists don't fully understand why it happens.

Wet macular degeneration can happen in a couple of ways:

1. New blood vessels growing in the wrong place. The choroid, a layer of blood vessels under the retina, sometimes grows new, unusual blood vessels that extend into the macula. This abnormal growth is called choroidal neovascularization. These new, abnormal vessels can leak fluid or blood into the macula. The fluid and blood damage the macula, making it harder to see clearly. The choroid is the layer of blood vessels between the retina and the tough outer covering of your eye (the sclera).

2. Fluid leaking into the eye. Fluid from the choroid can leak into spaces around the macula. This fluid might collect between the retinal pigment epithelium (a thin layer of cells) and the retina or within the layers of the retina itself. This buildup of fluid disrupts the structure of the macula, causing blurry or distorted vision.

Macular degeneration is a common eye disease that can lead to vision loss. Several factors can increase your risk.

• Age: Macular degeneration is most often seen in people over 50. As we get older, our eyes naturally change, and this can make us more vulnerable to this condition.

• Family history: If macular degeneration runs in your family, you have a higher chance of developing it yourself. Scientists have found specific genes that seem to be linked to a higher risk. This means that if your parents or other close relatives had macular degeneration, you might want to talk to your doctor about your risk.

• Race: Macular degeneration appears more commonly in people of white descent. The reasons for this difference are not completely understood, but research is ongoing.

• Smoking: Regular smoking or exposure to secondhand smoke significantly increases your risk of macular degeneration. This is because smoking damages blood vessels throughout the body, including those in the eye. Quitting smoking can help reduce your risk.

• Weight: Being overweight or obese may make macular degeneration worse. If you have early or intermediate macular degeneration, maintaining a healthy weight can help slow down the progression of the disease. This is because healthy blood vessels and overall health are important for preventing the disease from worsening.

• Heart health: Having conditions that affect your heart and blood vessels, such as high blood pressure, high cholesterol, or heart disease, can also increase your risk of macular degeneration. Healthy blood flow to the eyes is essential for good vision. Taking care of your heart health can help protect your eyes.

People with advanced wet macular degeneration, where central vision is significantly impaired, often face a higher risk of feeling depressed and becoming socially isolated. This is because a substantial loss of sight can sometimes lead to visual hallucinations. This is a condition called Charles Bonnet syndrome. Essentially, the brain, missing crucial visual input, may create its own images, which the person experiences as real.

Regular eye exams are crucial for spotting macular degeneration early. Macular degeneration is an eye condition that can lead to vision loss. Taking steps to protect your eyes can significantly lower your chances of getting this condition, especially the more serious wet form. Here are some helpful ways to do this:

• Quit smoking: Smoking significantly increases your risk of developing macular degeneration. If you smoke, talking to your doctor or a healthcare professional about quitting is a very important step. They can offer support and resources to help you succeed.

• Healthy lifestyle: Maintaining a healthy weight and getting regular exercise are important for overall health, and they can also help protect your eyes. If you need to lose weight, a balanced approach that involves eating fewer calories and increasing physical activity is recommended. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.

• Eat a colorful diet: Fruits and vegetables are packed with beneficial nutrients, including antioxidants. Antioxidants help protect your cells from damage, and this protection can reduce your risk of macular degeneration. Focus on a variety of colors in your diet; different colored fruits and vegetables offer a variety of beneficial antioxidants.

• Include healthy fats in your diet: Eating fish, and foods like walnuts, which contain omega-3 fatty acids, might help lower your risk of macular degeneration. Omega-3s are essential fats that play a role in overall eye health. Aim for at least a couple of servings of fish per week.

Understanding Macular Degeneration

Macular degeneration is an eye condition that gradually affects your central vision. It happens when the macula, the part of the eye responsible for sharp, detailed vision, deteriorates. There are two main types: dry and wet.

Dry Macular Degeneration:

In dry macular degeneration, tiny yellow deposits called drusen build up under the retina (the light-sensitive tissue at the back of the eye). These deposits are visible on eye exams. Early stages might just show these deposits, but as the condition progresses, the light-sensitive cells in the macula can die off, causing vision loss. This loss of cells is called atrophy.

Wet Macular Degeneration:

Wet macular degeneration is more serious. In this form, abnormal blood vessels grow under the retina. These new blood vessels can leak fluid and blood, leading to rapid vision loss.

How Doctors Diagnose Macular Degeneration:

Doctors use several methods to diagnose macular degeneration:

• Comprehensive Eye Exam: The doctor will review your medical history and family history of eye problems. They will then conduct a thorough eye exam. Eye drops are used to widen the pupils (dilate them) to see the back of the eye clearly. The doctor looks for signs of drusen, changes in the retina, or any other abnormalities.

• Amsler Grid Test: This simple test helps detect changes in central vision. You look at a grid of straight lines. If lines appear distorted, blurry, or missing, it could indicate macular degeneration.

• Additional Tests: If needed, doctors may use other specialized tests:

  • Examination of the back of the eye (fundus examination): The doctor uses a tool to look at the back of the eye. This may reveal yellow deposits (drusen) or other changes under the retina.
  • Fluorescein Angiography: A dye is injected into a vein in your arm. The dye travels to the blood vessels in your eye. Special pictures are taken to show the blood vessels and if there are any leaks or problems.
  • Indocyanine Green Angiography: Similar to fluorescein angiography, but uses a different dye. This test is often used to confirm or check for problems deeper within the retina.
  • Optical Coherence Tomography (OCT): This test uses light waves to create detailed images of the retina. It helps doctors see if there are any areas of thinning, swelling, or thickening in the retina, which can indicate damage from macular degeneration.
  • OCT Angiography: A more advanced OCT test that shows blood flow in the retina. This can help pinpoint areas of fluid leakage.

Managing Macular Degeneration:

Unfortunately, there's no cure for macular degeneration. However, treatments can sometimes slow the progression of the disease, especially in wet macular degeneration. Treatment options vary and depend on the type and severity of the condition. A doctor will recommend the best course of action.

Important Note: If you experience changes in your vision, it's crucial to see an eye doctor as soon as possible. Early detection and treatment can help preserve your vision.

Wet macular degeneration, a type of age-related macular degeneration, can lead to vision loss. Fortunately, treatments are available to potentially slow the progression of the disease and preserve sight. Early intervention may even help restore some lost vision.

Medications (Anti-VEGF Drugs):

These are the most common treatments for wet macular degeneration. They work by stopping the body from creating new blood vessels that leak fluid under the retina, a crucial part of the eye. These medications are injected directly into the affected eye by an ophthalmologist (eye doctor).

Common anti-VEGF drugs include:

• Bevacizumab (Avastin)
• Ranibizumab (Lucentis)
• Aflibercept (Eylea)
• Brolucizumab (Beovu)
• Faricimab-svoa (Vabysmo)

These injections are typically given every few weeks to maintain the medication's effects. As the new blood vessels shrink and the body absorbs the fluid, vision may improve.

Potential Risks of Injections:

While effective, these injections carry some risks, including:

• Bleeding in the eye (conjunctival hemorrhage):
• Infection:
• Retinal detachment: A serious condition where the retina separates from the back of the eye.
• Eye inflammation:
• Other side effects: Though less common, other side effects can occur, and your eye doctor will discuss these with you.

Other Treatment Options:

Two less common but still possible treatments are:

1. Photodynamic Therapy: In this procedure, a medicine (verteporfin) is injected into a vein in the arm. This medicine travels to the eye's blood vessels. A special laser targets and activates the medicine, causing the blood vessels to shrink and stop leaking. This can help improve vision and slow vision loss. However, it may need to be repeated over time, as the treated blood vessels might grow back. You might need to avoid bright light for a few days after the treatment.

2. Photocoagulation: A high-energy laser beam seals the problematic blood vessels under the macula. This helps stop bleeding and hopefully prevents further damage. However, the blood vessels may grow back, requiring more treatment, and the laser can cause scarring, creating a blind spot. This treatment is less effective for people with significant damage to the macula, and less often used than anti-VEGF drugs.

3. Low Vision Rehabilitation: Wet macular degeneration typically doesn't cause total blindness, but it can significantly reduce central vision. This loss of central vision makes everyday tasks like reading, driving, and recognizing faces difficult. A low vision rehabilitation specialist, occupational therapist, or eye doctor can help you adapt to the changes in your vision. They can teach you strategies to make daily tasks easier.

Important Note: The choice of treatment depends on various factors, including the stage of the disease and the individual's overall health. Discuss all treatment options with your eye doctor to determine the best approach for your specific situation.

Macular degeneration can make it hard to see things clearly, affecting tasks like reading, recognizing faces, and driving. Here are some ways to manage these changes:

Eye Care:

• Update your glasses: If you wear glasses or contacts, get a new prescription if needed. If new glasses don't improve your vision, ask your eye doctor for a referral to a low-vision specialist. They can help you with specific solutions tailored to your needs.

Magnification Tools:

• Magnifiers: These come in many forms, from handheld lenses to magnifying glasses you wear like regular glasses. They can help with close-up tasks like reading and sewing. Closed-circuit television (CCTV) systems use a camera to magnify text on a screen, which can be very helpful.

Technology Adjustments:

• Computer settings: On your computer, increase the font size and adjust the monitor's contrast to make the screen easier to see. You can also add speech-output systems or other assistive technologies that read aloud text on the screen.

• Electronic reading aids: Large-print books, tablet computers, and audiobooks can be easier to read. Many tablet and smartphone apps are designed for people with low vision, and more now have voice recognition features that read aloud text.

• Special appliances: Some clocks, radios, telephones, and other appliances are designed with extra-large numbers or displays to make them easier to use.

Home Adaptations:

• Lighting: Better lighting in your home can help with reading and everyday activities. Bright light can also help reduce the risk of falls.
• TV viewing: A larger high-definition TV screen, or sitting closer to the TV, can make it easier to watch.

Transportation:

• Driving: If you drive, talk to your doctor about whether it's still safe for you to drive. Be extra cautious in situations like driving at night, in heavy traffic, or in bad weather. If driving becomes difficult, consider using public transportation, ride-sharing services, local van services, or asking a friend or family member for help.

Emotional Support:

• Counseling and Support: Adjusting to vision loss can be emotionally challenging. Talking to a counselor or joining a support group can be very helpful. Connecting with supportive family members and friends is also crucial during this time.

These are just some suggestions. It's important to work with your eye doctor and other specialists to find the best solutions for your specific needs and circumstances. Don't be afraid to ask questions and explore different options.