It can happen abruptly. When it does, you’ll know.
Like the day you looked at the blinds in your house and where there used to be straight slats, you suddenly saw wiggly lines.
Or when you were in the middle of reading an article on your tablet, and letters abruptly started disappearing, right off the screen. You squinted, closed one eye and then the other, and reached for your reading glasses. You knew the letters must be there. Only you couldn’t see them.
Could it be that you’re imagining it?
Or maybe—and this maybe is a big deal—you aren’t.
Both of these moments can be sneaky signs of wet age-related macular degeneration (or wet AMD), a serious, progressive, chronic eye disease that can lead to permanent central vision loss. Understanding the condition is the first step to treating it. Knowing how to spot symptoms is equally critical, since early detection can keep it from wreaking havoc on your sight.
What Is Wet AMD?
Wet AMD is typically caused by abnormal blood vessels that leak fluid or blood into your macula. The macula is the is the most sensitive part of the retina which is the back layer of the eye. Over time, this can lead to scarring and atrophy, says Rukhsana G. Mirza, M.D., an associate professor of ophthalmology and medical education who specializes in diseases of the retina at Feinberg School of Medicine at Northwestern Medicine in Chicago.
The macula has a big role: It is responsible for central vision. Think of anything that you see throughout the day without turning your head or looking sideways—that’s courtesy of your macula. When there’s damage due to wet AMD, vision loss can occur.
Your eye doctor will determine if you have wet AMD by viewing an OCT or non-invasive imageing test that shows if there is leakage of fluid or hemorrhage in the eye. But to get the test, first you have to see your doc. So how do you know if it’s time to get your vision checked out? Here are seven signs.
Sneaky Sign #1: You’re Struggling to Identify Faces
It’s odd (and a little embarrassing): You feel like you know this person saying hi to you in the grocery store, but you’re straining to make out the features on her face, even though she’s right in front of you. Or maybe you do know who this person is, but if you stop and think about it, you’ve ID’d your neighbor not by her face, but by the sound of her voice, or laugh, or maybe her perfume.
Difficulty in identifying details of someone’s face is a definite red flag for wet AMD—don’t wait to see your eye doctor. “We have so many patients that chalk up the blurriness to cataracts or needing new glasses,” says Jason Hsu, M.D., an attending surgeon on the retina service at Wills Eye Hospital in Philadelphia. “They wait months to be seen, and those are the folks that we end up finding out already have a big scar in their retina. At that point, we can try an injection, but often it doesn't help bring back any useful vision.”
Sneaky Sign #2: You’re Living in a Distorted World
Things are not always what they seem with wet AMD—lines can become distorted, especially when you look directly at them. Living in a fun house is definitely not fun—especially if you run into the corner of a door or table that looks curvy to you but is really pointy-sharp. Straight lines can appear curvy, and this can be especially dangerous while driving. Distorted vision is frequently a sign that your wet AMD is progressing (or if you have the slower-progressing disease, dry AMD, it may be advancing). About 10% to 15% of patients with dry macular degeneration will progress to wet AMD.
Some people with wet AMD use this distortion to their advantage: They stare at their blinds at home to assess the state of their vision. If the solid rows are suddenly wavy, they know their eye condition might be progressing and head to their doctor for an adjustment in treatment.
An Amslet Grid is a dark grid pattern on a piece of paper that a patient can use at home to cover one eye and stare at the center of the grid with the other eye. If lines appear wavy instead of straight or are missing in parts of the grid, it could be an indication that wet ARMD is present and one should not wait to see his/her eye doctor.
Sneaky Sign #3: Reading Is a Real Challenge
If letters seem like they’re just disappearing from the page, that’s a key indicator of wet AMD, says Dr. Mirza. Try covering one eye at a time—if you can’t see certain letters in front of you (but when turn your head and look from the corner of your eye, there they are again!), it's likely that your central vision is deteriorating. This differs from cataracts and refractive errors (meaning you need new glasses), the blurry vision is constant, no matter where you look.
Sneaky Sign #4: Just What Color Is That?
Here’s something that might surprise you: Wet AMD causes loss of full color vision. The reason? Your macula contains many photoreceptor cone cells, and they’re responsible for seeing in color. While it’s the brain’s job to actually perceive that color, the brain relies on signals sent by those cone cells to determine just what it’s seeing. With wet AMD damage, blue, green, and red hues are still perceivable, but other colors are often not. (An important note: This is not the same as color blindness; it’s a direct result of the eye disease.)
If you notice colors appear different from each eye or you can’t see certain colors, or that the world has suddenly become muted, see your eye doctor right away.
Sneaky Sign #5: Now You See It, Now You Don’t
Have you started doubting yourself, wondering if that flash of something—light, stars, the outline of a person—was real?
Hallucinations can be a hallmark of wet AMD, especially in people with more advanced stages of the disease. “They usually happen in folks who have had quite a bit of central vision loss,” Dr. Hsu explains. There’s a name for it, Charles Bonnet syndrome, and it can happen to anyone with an eye disease that causes vision loss.
Here’s what occurs: “In people with wet AMD, the light receptors in the eye aren’t working anymore, so signals aren’t being sent back to the brain,” says Dr. Hsu. “But the vision centers in the brain are so used to seeing everything, when they don’t get that input from the center part of the retina anymore, they just start to fill in the blank spots with other images.”
Patients have reported flashes of light, colors, and patterns (“someone told me they could see paisley over everything,” Dr. Hsu says). Even dancing children (sweet) and bugs covering the walls (ick) have been reported. Unfortunately, there’s currently no treatment to stop these hallucinations, but they often occur briefly, then disappear on their own.
Sneaky Sign #6: It’s Just One Eye
Another hallmark of AMD is that it starts in the dry form, and then can progress to wet. As it advances, symptoms might not be “bilateral”—the fancy medical term for affecting both eyes at once—so you may have one dry AMD eye and one wet AMD eye. It’s vital to monitor both eyes with dry AMD, to ensure you don’t miss signs of wet AMD in one eye.
How, exactly, to do that? While some new exciting technologies are helping in this regard, Dr. Mirza has her patients do it old-school at home, by looking regularly at what’s called the Amsler Grid. Macular degeneration does not progress at the same rate in both eyes. One eye could have dry AMD and the other can worsen to wet AMD. It is important to periodically cover each eye to see the difference as well as use the Amsler Grid, otherwise symptoms of wet AMD can easily be missed.
Sneaky Sign #7: Your Vision Quality Is Diminishing
Having trouble seeing as well as you used to? Feel like your vision quality itself is slipping? You could be losing lines of vision, as well as the ability to see well both near and far in the center part of your vision, due to wet AMD.
In the worst-case scenario, losing vision from wet AMD means you can’t drive, you can’t read, and you can no longer do hobbies where you rely on fine details. The good news, though (you didn’t think we’d leave you hanging, did you?) is that spotting wet AMD early and getting proper treatment can help you maintain or even improve your eyesight. “Some patients can regain vision with current treatment options,” Dr. Mirza says. “As their eye anatomy improves generally, their vision can improve with it.”