Do You Know the Early Signs of Wet AMD?
You might not realize your vision loss is progressing with wet AMD. Here’s what to look for (and what to do about it).
One day in 2015, Liz Rundzieher stopped at her refrigerator and looked at the Amsler grid hanging there to test her vision—something she did often. But this time, instead of seeing the grid’s straight lines, running up and down in the shape of a square with a small circle in the middle, she saw something new. Something different.
She covered her right eye. The lines were straight. She covered her left eye. The lines were wavy. Rundzieher, 74, of Houston, knew what she had to do. “I didn’t wait. I called [the eye doctor] that day to make an appointment. And the minute I said to the appointment service what that was happening, they were very good about getting me an appointment quickly,” she says.
Rundzieher had been diagnosed with dry age-related macular degeneration (AMD) several years earlier in both eyes, and knew this visual change was a possible symptom of progression to the next—and last—stage of the ocular disease, called wet AMD. Her doctor confirmed her suspicion, and Rundzieher was diagnosed with wet AMD in her right eye at that visit six years ago; she’s been receiving anti-VEGF treatment ever since.
Her story illustrates how knowing the signs and symptoms of this serious condition—as well as seeing your eye doctor regularly to monitor for any unseen changes and then sticking to your treatment plan once diagnosed—might just save your central vision.
The timing of detecting AMD progression is key to how well therapy might work to not only stop central vision loss, but also possibly restore lost vision, says Carl C. Awh, M.D., president of the American Society of Retina Specialists (ASRS) and a retina specialist at Tennessee Retina in Nashville. The first-line treatment for wet AMD, anti-VEGF injections have shown in clinical trials to stabilize vision in more than 90% of patients, with a third of patients gaining vision. “The better the vision when we begin treatment, the better the vision the patient will end up with,” he explains.
So what should you be on the lookout for?
Be Wary of Wavy Lines
Here’s the tricky thing about AMD. You might not have any signs or symptoms that you’ve progressed from dry to wet. “Sometimes quite honestly, they’re missed,” says Sophie J. Bakri, M.D., a retina specialist and chair of ophthalmology at the Mayo Clinic in Rochester, MN. She explains that one eye can compensate for the other eye’s vision loss. It’s like our brain is telling us we’re seeing out of both eyes just fine, even though one isn’t seeing as well.
“One of the signs of converting from dry to wet is that straight lines appear wavy, and also may be missing parts,” Dr. Bakri says. “Within those straight lines [of an Amsler grid], it’s like a crossword puzzle with multiple missing blotches. So, some people notice general blurriness, others notice distortion.”
Simply, signs or symptoms of progression to wet AMD can include:
Missing spots in your central vision
It’s important to note that only 10% to 15% of patients with dry AMD will progress to wet macular degeneration, Dr. Awh says, meaning that just because you have dry AMD doesn’t mean you’ll advance to wet. So what increases your odds?
Wet AMD Risk Factors
For Rundzieher, it was seeing wavy lines that signaled her progression to wet AMD. But the reason she noticed them, and even knew to check her vision regularly with an Amsler grid, was because she knew she was at risk for the condition. Specifically, her dry AMD diagnosis and her family history of wet AMD helped lead her to act swiftly.
Other risk factors can come into play, too, like:
Light iris color
History of heavy drinking (four or more alcoholic drinks per day)
Other possible risk factors include hypertension (high blood pressure), excessive sun exposure, and a diet deficient in fruits and vegetables.
Rundzieher’s genetic connection to wet AMD made her aware of her risk of developing the condition. She’d seen it play out in her family. Her mom, one of nine children, had wet AMD. Four of her mother’s siblings had it, too, and possibly her great-grandmother. Because all of her relatives had the eye condition before anti-VEGF treatment was approved for wet AMD in the early 2000s, she witnessed her mom, uncles, and aunts all progress until they’d lost central vision.
“I can remember them setting up their households so that they could feel their way through and know where everything was,” Rundzieher says. “There was one aunt in particular, I could really see that look in her face when she was trying to discern whose face she was looking at. She could see the perimeter of their face, but she couldn’t see the interior. She had adaptive things in her house to help enlarge things. And she sought out ways to stay connected, and wanted to remain connected with the world. It scared me to think of that happening for me.”
How to Catch Wet AMD Early
Rundzieher did everything right when she first saw those wavy lines, says her ophthalmologist, Christina Y. Weng, M.D., M.B.A., a retina specialist and associate professor of ophthalmology and fellowship program director of Vitreoretinal Surgery and Diseases at Baylor College of Medicine in Houston. “We very much wish all patients would be as sensitive and proactive about their care,” Dr. Weng says.
If wet AMD runs in your family, or if you have dry AMD and are concerned about your vision changing, follow these steps to catch wet AMD early:
Have regular eye exams. Dr. Weng explains that your eye doctor has special tools to detect wet AMD earlier than you might be able to see it.
Self-monitor vision. While those regular eye exams are everything, your eye doctor typically sees you twice a year if you have dry AMD, Dr. Weng says, so it’s important for you to know how to recognize symptoms using an Amsler grid to monitor changes daily.
Seek out a specialist. Seeing an eye doctor trained in retinal issues can also be helpful in making sure you’re properly diagnosed, treated, and monitored with wet AMD, Dr. Awh says. He recommends using the American Society of Retina Specialists’ Find a Retina Specialist feature feature to locate a specialist near you.
Because Rundzieher caught her wet AMD early on and is consistent with her treatments and eye exams, she’s maintained her vision. She can watch TV, pay her family’s bills, and read for pleasure. As a retired teacher, she’s been able to support her 7-year-old granddaughter’s virtual learning through the pandemic. She needs glasses to help clarify things in her weakened right eye, submits to anti-VEGF injections every 10 weeks, and carefully monitors her left eye’s dry AMD, but she’s OK with that. Because she can see her granddaughter.
“Sometimes if I take my glasses off and I try to look at my granddaughter, so much is lost in the center of her face. I tried to imagine if I couldn’t see those eyelashes that are so long, and if I couldn’t see those lovely details, I would miss that so much,” she says. “I know that the glasses are helping to make a difference. I know the injections are helping me to hold my own. So it’s all put together to make it work. I know it’s a fragile thing. I know that there’s no predictability about the other eye transitioning to wet. But I am just taking each day with gratitude.”
Progression from Dry to Wet AMD: BrightFocus Foundation. (2019.) “Monitoring the Progression of Dry Age-Related Macular Degeneration.” https://www.brightfocus.org/macular/article/monitoring-progression-dry-age-related-macular
AMD Stats: National Eye Institute. (2019.) “Age-Related Macular Degeneration (AMD) Data and Statistics.” https://www.nei.nih.gov/learn-about-eye-health/resources-for-health-educators/eye-health-data-and-statistics/age-related-macular-degeneration-amd-data-and-statistics
Risk Factors: International Journal of Molecular Sciences. (2021.) “Neovascular Macular Degeneration: A Review of Etiology, Risk Factors, and Recent Advances in Research and Therapy.” https://www.mdpi.com/1422-0067/22/3/1170
Smoking and AMD: British Journal of Ophthalmology. (2020.) “Smoking and Treatment Outcomes of Neovascular Age-Related Macular Degeneration Over 12 Months.” https://pubmed.ncbi.nlm.nih.gov/31558491/
Genetic Risk Factor: MedlinePlus. (2020.) “Age-Related Macular Degeneration.” https://medlineplus.gov/genetics/condition/age-related-macular-degeneration/#causes
OCT: American Academy of Ophthalmology. (2020.) “What Is Optical Coherence Tomography?” https://www.aao.org/eye-health/treatments/what-is-optical-coherence-tomography