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How to Recognize Wet Macular Degeneration

  • Synopsis: Published: 2015-05-21 (Rev. 2017-06-26) - Information regarding wet macular degeneration, one of two forms of age-related macular degeneration. For further information pertaining to this article contact: Thomas C. Weiss at Disabled World.

Definition: Macular Degeneration

Macular degeneration, often age-related macular degeneration (AMD or ARMD), is a medical condition that usually affects older adults and results in a loss of vision in the center of the visual field (the macula) because of damage to the retina. It occurs in "dry" and "wet" forms. AMD is a common eye condition and a leading cause of vision loss among people age 50 and older.

Dry AMD - Age-related macular degeneration begins with characteristic yellow deposits (drusen) in the macula, between the retinal pigment epithelium and the underlying choroid.

Wet AMD - Neovascular or exudative AMD, the "wet" form of advanced AMD, causes vision loss due to abnormal blood vessel growth (choroidal neovascularization) in the choriocapillaris, through Bruch's membrane.

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"Early detection and treatment of wet macular degeneration might help to reduce loss of vision, while in some instances it may improve the affected person's vision."

Wet macular degeneration is a form of chronic eye disease. It causes vision loss in the center of a person's field of vision. Wet macular degeneration is usually caused by abnormal blood vessels that leak blood or fluid into the region of the macula. The macula is in the center of a person's retina.

Wet macular degeneration is one of two forms of age-related macular degeneration. The other form, dry macular degeneration, is more common and also less severe. Wet macular degeneration nearly always starts as dry macular degeneration. The cause of wet macular degeneration remains unclear at this time. Early detection and treatment of wet macular degeneration might help to reduce loss of vision, while in some instances it may improve the affected person's vision.

Symptoms of Wet Macular Degeneration

The symptoms of wet macular degeneration usually appear and then progress at a rapid pace. There are some different symptoms associated with wet macular degeneration. These symptoms can include the following:

  • Abrupt onset
  • Rapid worsening
  • Decreased central vision
  • Decreased brightness or intensity of colors
  • Well-defined blind or blurry spot in the person's field of vision
  • Hallucinations of people, animals, or geometric shapes in instances of advanced macular degeneration
  • Visual distortions such as straight lines that appear crooked or wavy, objects appearing further away or smaller than they actually are, or a street sign or doorway appearing lopsided

It is important to visit a doctor if your ability to see fine details and colors decreases. It is also important to visit your doctor if you notice changes in your central vision. The changes might be the first indicators of macular degeneration, especially if you are over the age of fifty.

Causes of Macular Degeneration

The cause or causes of wet macular degeneration remain unknown. The condition almost always develops in those who have experienced dry macular degeneration. Yet doctors are not able to predict who will develop wet macular degeneration, a condition that is more severe and progresses more quickly than dry macular degeneration. Wet macular degeneration may develop in some different ways to include:

Fluid and the RPE: The fluid beneath the retinal pigment epithelium (RPE) causes what appears to be a bump or blister under the person's macula.

Vision Loss Caused by Fluid Buildup: Vision loss caused by fluid buildup in the back or the person's eye. Wet macular degeneration at times can develop when fluid leaks from the choroid and collects between the choroid and a thin cell layer called the, 'retinal pigment epithelium,' causing retinal pigment epithelium detachment.

Vision Loss Caused by Abnormal Blood Vessel Growth: Wet macular degeneration might develop when abnormal new blood vessels grow from the person's choroid, the layer of blood vessels between the retina and the firm outer coat of the person's eye called, 'sclera,' under and into the macular part of the retina. The condition is called, 'choroidal neovascularization. The abnormal vessels might leak blood or fluid between the person's choroid and macula. The fluid interferes with the retina's function, causing the person's central vision to blur. In addition, what the person sees when they look straight forward becomes crooked or wavy and blank spots block out a portion of the person's vision.

Risk Factors for Macular Degeneration

Some different risk factors for macular degeneration exist. Factors that might increase a person's risk of macular degeneration include the following:

Race: Macular degeneration is more common in white people than other races.

Smoking: Smoking cigarettes increases a person's risk of macular degeneration.

Diet: A diet including vegetables and fruit might decrease the risk of macular degeneration.

Family History: If a person in your family experienced macular degeneration you are more likely to develop macular degeneration.

Inflammation: A person's immune system may cause swelling of their body tissues, something that may increase the risk of macular degeneration.

Inflammation: A person's immune system may cause swelling of their body tissues, something that might increase their risk of macular degeneration.

Cardiovascular Disease: If you have experienced diseases that affect your blood vessels and heart, you might be at increased risk of macular degeneration.

Obesity: Being severely overweight increases the chance that early or intermediate macular degeneration will progress to the more severe form of the disease.

Age: A person's risk of macular degeneration increases as they age, particularly after the age of fifty. Macular degeneration is most common in people over the age of sixty-five.

Testing For and Diagnosing Macular Degeneration

Doctors will review your medical and family history and conduct a comprehensive eye examination in order to diagnose your condition. Doctors may conduct a number of tests to diagnose wet macular degeneration as well. These tests may include the following:

An Examination of the Back of Your Eye: Your eye doctor will examine the back of your eye to look for blood or fluid. The doctor will put eye drops in your eyes to dilate them and use an optical device to examine the back of your eye.

A Test for Defects in Your Central Vision: During an eye exam, your eye doctor might use an, 'Amsler,' grid to test for defects in the center of your vision. Macular degeneration may cause the straight lines in the grid to seem broken, faded, or distorted.

A Certain Camera: A camera takes a number of pictures of the blood vessels in your eye as the dye travels through your blood vessels. The images will reveal if you have retinal abnormalities or blood vessels that may be associated with wet macular degeneration.

A Fluorescein Angiongram: During an angiogram of your eye, the doctor injects a colored dye into a vein in your arm. The dye then travels to the blood vessels in your eye and highlights the blood vessels. The dye will identify abnormal sites in your blood vessel walls that may be leaking.

An Optical Coherence Tomography: The test is noninvasive and displays detailed cross-sectional images of your eye. The test identifies retinal abnormalities such as swelling of the retina, or leaking blood vessels in your eye. It is often times used to help monitor the response of the retina to macular degeneration treatments.

Treating Macular Degeneration and Drugs

Wet macular degeneration is something that cannot be cured at this time. If it is diagnosed early, treatment might help to slow the progress of macular degeneration and reduce the amount of vision a person loses. Medications may help to stop growth of new blood vessels by blocking the effects of growth signals your body sends to generate new blood vessels. The medications are considered to be the first-line treatment for every stage of wet macular degeneration. Medications used to treat wet macular degeneration include:

  • Aflibercept
  • Pegaptanib
  • Ranibisumab
  • Bevacizumab

A doctor injects these medications directly into a person's eye. You might undergo repeat injections every month to maintain the beneficial effect of the medication. Sometimes, you may partially recover vision as the blood vessels shrink and the fluid under your retina absorbs, permitting retinal cells to regain some level of functionality. Some of these medications might increase a person's risk of experiencing a stroke.

Photodynamic Therapy

Photodynamic therapy is used to treat abnormal blood vessels at the center of a person's macula. In the procedure a doctor injects a medication called, 'verteporfin,' into a vein in your arm, which then travels to blood vessels in your eye. The doctor shines a focused light from a laser to the blood vessels in your eye, activating the medication within the blood vessels. The medication can then cause the blood vessels in your eye to close, stopping leakage.

Photodynamic therapy might improve your vision and reduce the rate of lost vision. You might need repeated treatments over a period of time because your blood vessels may reopen. Following photodynamic therapy, you will need to avoid intensely bright lights and direct sunlight until the medication has cleared your body - something that might take a few days.

Laser Destruction of Abnormal Blood Vessels

During laser therapy, a doctor uses a high-energy laser beam to destroy abnormal blood vessels under a person's macula. The procedure is used to prevent additional damage to the person's macula while slowing continued loss of vision. Laser therapy is used to treat wet macular degeneration, but only in certain situation. It usually is not an option if you have abnormal blood vessels directly under the center of your macula. The more damaged a person's macula is, the lower the likelihood of functional success. Due to these restrictions, few people who have wet macular degeneration are candidates for laser therapy.

Preventing Macular Degeneration

Measures exist that can help you to avoid macular degeneration. These measures can include the following:

Quit Smoking: Smokers are more likely to develop macular degeneration than nonsmokers. Ask your doctor for assistance with quitting smoking.

Routine Eye Examinations: Ask your doctor how often you should pursue routine eye examinations. A dilated eye examination may identify macular degeneration.

Fish: Include fish in your diet. Omega-3 fatty acids found in fish might lower your risk of macular degeneration. Nuts such as walnuts also contain omega-3 fatty acids.

Vegetables and Fruits: Choose a healthy diet that is full of a variety of vegetables and fruits. The foods contain antioxidant vitamins that lower your risk of developing macular degeneration.

Management of Other Medical Conditions: For example, if you have high blood pressure or cardiovascular disease, take your medication and follow your doctor's instructions for controlling the condition.

Weight and Exercise: If you need to lose weight, cut the number of calories you consume and increase the amount of exercise you receive every day. Maintain a healthy weight by exercising on a regular basis and controlling what you eat.

Awareness: Vision Disability Awareness

White awareness ribbonApproximately 285 million people worldwide live with low vision and blindness. The white awareness ribbon represents blindness.

October is Blindness Awareness Month - World Blindness Awareness Month was established for every October to help people understand the realities of living without sight. As part of Eye Care Awareness Month people are encouraged to have an annual eye exam. October has also been declared Children's Vision Month to encourage parents to book annual eye exams for their children to ensure their eye health.

World Sight Day - A global event that focuses on bringing attention on blindness and vision impairment. It is observed on the second Thursday of October each year.

Facts: MD Adaptive Devices

Because peripheral vision is not affected, people with macular degeneration can learn to use their remaining vision to partially compensate. Assistance and resources are available in many countries and every state in the U.S. Classes for "independent living" are given and some technology can be obtained from a state department of rehabilitation. Adaptive devices can help people read. These include magnifying glasses, special eyeglass lenses, computer screen readers, and TV systems that enlarge reading material. Computer screen readers such as JAWS or Thunder work with standard Windows computers. Accessible publishing provides larger fonts for printed books, patterns to make tracking easier, audio-books and DAISY books with both text and audio.

Statistics: Macular Degeneration

  • About 1.75 million U.S. residents currently have advanced age-related macular degeneration with associated vision loss, with that number expected to grow to almost 3 million by 2020.
  • The dry form is more common than the wet form, with about 85 to 90 percent of AMD patients diagnosed with dry AMD. The wet form of the disease usually leads to more serious vision loss.


Related:

  1. New Telescopic Contact Lenses Could Improve Sight for Macular Degeneration Patients - The Optical Society - (2013-06-27)
    https://www.disabled-world.com/disability/types/vision/amd-contacts.php
  2. Age-Related Macular Degeneration Disease Breakthrough - Trinity College Dublin - (2012-04-16)
    https://www.disabled-world.com/disability/types/vision/inflammasome.php
  3. Macular Dystrophy: Types, Causes, and Treatments - Thomas C. Weiss - (2014-11-17)
    https://www.disabled-world.com/disability/types/vision/macular-dystrophy.php



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