Let's Talk About Wet Age-Related Macular Degeneration Treatment
It's a serious disease—with highly successful treatment options. Here's what the experts say is your best approach if you've been diagnosed with wet AMD.
Your blurry vision turned out to be way more than a small problem. You have wet AMD and you’ll need treatment for the eye disease starting now and into the future, to prevent vision loss and help you regain eyesight that’s been diminished. Find out more about the current methods for treating this chronic condition.
Our Pro Panel
We went to some of the nation's top retina specialists in ophthalmology to bring you the most up-to-date information possible.
Jason Hsu, M.D.
Retina Specialist, Attending Surgeon
Wills Eye Hospital
Rukhsana G. Mirza, M.D.
Retina Specialist, Associate Professor of Ophthalmology and Medical Education
Feinberg School of Medicine at Northwestern Medicine
Timothy G. Murray, M.D.
American Society of Retina Specialists
Also called neovascular AMD (or age-related macular degeneration), this type of eye disease is a progression of dry AMD. Wet AMD is the late stage of the disease, with a major impact to the macula, which is responsible for the central part of your vision.
First-line treatment for wet AMD is called anti-VEGF therapy. This medication targets the VEGF protein in your eye involved in blood vessel growth, aiming to stop new, weak vessels from growing. Anti-VEGF drugs are given as a shot in the eye.
Prior to the approval of the first anti-VEGF therapy for wet AMD in 2004, two laser therapies were available, first laser photocoagulation surgery and then photodynamic therapy (PDT), but they weren’t effective for all wet AMD patients, and had real issues involved in their treatment. Anti-VEGF is the more common treatment now.
Experimental treatments (not yet FDA-approved) include a small implant in the wall of the eye that releases anti-VEGF medication for up to 15 months before it needs to be refilled. Another approach uses gene therapy to block VEGF production for years. And new drugs are being developed to enhance the effectiveness of anti-VEGF meds.
Wait, What's Wet AMD Again?
An estimated 14 million Americans have some form of age-related macular degeneration (AMD). They tend to be older—the disease often starts after age 50 with a proliferation of deposits in the eye called drusen. The majority of people who develop AMD are Caucasian. The disease is also linked to genetics and smoking.
There are two types of AMD: Dry and wet. Dry AMD is the early stage of the disease and has little to no symptoms. Wet AMD, also called neovascular AMD, is the late stage of the disease and has a major impact on the macula, the part of your eye responsible for central vision. Although wet AMD accounts for only about 10% to 20% of all AMD cases, it attributes to about 90% of legal blindness caused by AMD.
In wet AMD, symptoms can include:
Loss of vision in the center of the eye
Blind spots in the center vision
Blurriness, but only in the center of your vision (you can see just fine looking up and down and side to side)
Distortion of straight lines
In wet AMD, vision loss occurs because of the creation of new, weak blood vessels that grow into the macula and then leak fluid, lipids, or blood. This is known as choroidal neovascularization (CNV) and it’s important to know, because it’s directly related to the current treatment for wet AMD.
What Treatments Are Available for Wet AMD?
The main, first line of treatment for wet AMD is called anti-VEGF therapy. This medication targets the vascular endothelial growth factor (VEGF) protein involved in creating new, fragile blood vessels in the eye that ooze blood or fluid, causing vision loss. These drugs don’t make the blood vessels go away, but they do stop them in their leaky tracks.
Anti-VEGF drugs are given as a shot in the eye. Yes, your eye. And brace yourself—because wet AMD is usually a chronic eye disease, you’ll likely need anti-VEGF treatment more than once.
How often you’ll receive the drug will be based on your individual needs, meaning you could have an injection every 4 weeks to every 6 months or so. Treatment often starts at every 4 weeks for 3 months, and then changes duration based on your situation and how you respond to the meds.
The U.S. Food and Drug Administration (FDA) has approved these anti-VEGF drugs for wet AMD treatment:
Ophthalmologists may also use Avastin (bevacizumab) as an “off-label” treatment, meaning it hasn’t been approved by the FDA for this use. The drug was originally developed to treat metastatic colon cancer—it prevents blood vessel growth in cancer tumors. In wet AMD, it may work in a similar way, slowing progression by restricting the growth of new blood vessels in the eye.
Doctors are allowed to prescribe drugs for uses other than what they were originally approved for if they think they’re needed and if studies show the drug is helpful for the new use, and enough studies show Avastin is effective in wet AMD for it to be considered a treatment option.
On the market in the U.S. for the last two decades, anti-VEGFs have revolutionized the way wet AMD is treated. Prior to 2004, two laser therapies were available, first laser photocoagulation surgery and then photodynamic therapy (PDT), but they weren’t effective for all wet AMD patients, and often caused complications in treatment for the disease.
Laser photocoagulation surgery: In this method, a hot laser is used to heat, seal, and destroy abnormal blood vessels. But it can also result in a permanent blind spot from scarring. Surgery needs to be repeated, too, if new blood vessels grow.
PDT: This method has been most useful in a subtype of wet AMD known as predominantly classic subfoveal AMD. In PDT, a cold laser therapy is used in conjunction with a chemical injected into your arm called Visudyne (verteporfin), that attacks the unhealthy blood vessels in your eye. This treatment can be combined with anti-VEGFs for the best efficacy.
Anti-VEGFs do come with some potential side effects, too, including blurred vision, cataracts, broken blood vessels in the eye, floaters, eye pain, and an eye infection called endophthalmitis. Talk to your doctor if you experience any changes in your eye that concern you after having these drugs injected—they’re safe, but any drug comes with risks.
What Is Anti-VEGF Treatment Like?
Wondering how the process of having a needle with anti-VEGF medication injected into your eye goes? Let’s walk through it, step-by-step.
You’ll be awake throughout the experience.
You lie on a bed (or a chair, leaned back) in your ophthalmologist’s office or operating room.
Your face will probably be “draped”—a surgical cover will be placed over it for safety from infection, with a hole cut out for your eye.
Your eye will be numbed, typically. This could be with an eye drop, a gel, a cotton tip soaked with an anesthesia that’s applied directly to your eye, or even a superficial injection.
Your eye will be cleaned with a sterile iodine solution. This might sting a little—after all, it’s surgical soap.
Some doctors will hold your eye open with an eyelid opener (it’s called a lid speculum). Others ask an assistant to hold your eye open. In some cases, your doctor might even ask you to keep it open!
Some doctors will measure where the injection will be placed, which is typically in the lower, outer corner of the eye, in the white part. So you might never see the needle—either coming at you, or even in the room, especially if you ask your doctor not to.
Your doctor will give you the injection with a tiny needle. You might feel a little pressure, or nothing. It should take seconds to administer the drug.
You might see lines in your vision as the medicine and fluids mingle in your eye. It might feel a little like you have sand in your eye. Important: Don’t rub your eye! Let your doctor know what you’re feeling, and ask what you can do to deal with any discomfort.
The whole process takes about 15 minutes, tops. After, your doctor may examine your eye with a light and clean the area. You might need to take antibiotic eye drops for several days. If your eye is sore, you can take an over-the-counter pain medication.
If it’s your first time receiving the treatment, consider asking a friend to help you get home—it might not be best to drive if you have any visual issues. Once you know how you respond to treatment, you might be able to drive home on subsequent treatments, sight permitting.
Can Vitamins Treat Wet AMD?
If you previously had dry AMD, you may have taken vitamins to improve your eye health: Doctors commonly prescribe the AREDS2 formulation. This compound is based on important study findings showing that a combination of the following vitamins can reduce the progression of dry AMD by 25%:
Lutein 10 milligrams (mg)
Vitamin C 500mg
Vitamin E 400IU
Zinc oxide 80mg or 25mg
Cupric oxide 2mg
Unfortunately, these vitamins work to slow dry AMD progression, not wet AMD. So by the time you’ve progressed to wet AMD, they might not be as effective. Still, there’s likely little downside to taking them: Talk to your doctor about whether AREDS2 are a good option for you to take with wet AMD.
What Are Signs My Condition Is Getting Worse?
Eventually, anti-VEGF therapy wears off, and your eye becomes vulnerable to the progression wet AMD. These are good ways to tell if the disease is worsening—if you have any of these symptoms, see your doc now. Do not wait for your next appointment, in case damage is being done to your eye.
Seeing wavy. Cover one eye. Look at a doorway or window, an Excel spreadsheet, or an Amsler grid (the common AMD visual test, showing a grid lines with a dot in the center). Are the lines distorted? Try it with the other eye. Distorted lines or inability to see the dot means it’s time to call your doctor.
Testing at home. The ForseeHome Monitor is an FDA-approved device that detects vision distortion via a daily, 3-minute-per-eye test, and sends a monthly report to your doctor. Some studies suggest AMD patients get more accurate results with ForseeHome than the Amsler grid. The device is often covered by Medicare and private insurance.
Missing words. Central vision loss from wet AMD makes words right in front of you on a page disappear. Watch for it increasing or worsening in both eyes, and notify your doctor if it does.
Blurring faces. If you notice a sudden blurriness that makes it really hard to discern details on the faces of friends and loved ones, it’s a definite sign of wet AMD. Wait 24 hours. Still a problem? Phone your eye doctor and ask for an urgent exam.
What's the Future of Wet AMD Treatment?
While anti-VEGF treatment has been successful in helping patients with wet AMD, it’s not without its issues. It has side effects. It has the freaky factor of requiring injections into your eye. And it has a huge treatment burden, meaning you have to return for injections on a regular basis. If you miss treatments, you could have visual loss.
Researchers are on the hunt for new treatments for wet AMD that reduce the amount of injections you need, and make the treatment burden far less. Future potentials include:
Port delivery system. This microscopic device, surgically implanted into the wall of the eye, holds medicine (Lucentis) that is released continuously. It eliminates the need for regular injections (but requires a refill possibly every 15 months). The device is in a final phase 3 trial now, with results expected in the next year.
Gene therapy. This genetic modification could potentially block VEGF for years instead of weeks and months. One treatment, RGX-314, is done through a surgical procedure where a virus that has an anti-VEGF gene is injected under the retina.
New drugs. Additional medications could enhance the effectiveness of anti-VEGFs, or work as alternatives for patients who don’t respond well to current drugs.
At the end of the day, dealing with wet AMD is tiring—and frightening. Know that you are doing the right thing by staying on top of your treatment. The more proactive you are in your care now, the better your odds of stabilizing, or even improving, your vision for the rest of your life.
- Wet AMD Definition: The Organization of the Retina and Visual System. (2008). “Age-Related Macular Degeneration.” ncbi.nlm.nih.gov/books/NBK27323/
- Wet AMD and Treatments: National Eye Institute. (2019). “Treatments for Wet AMD (Advanced Neovascular AMD).” nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration/treatments-wet-amd-advanced-neovascular-amd
- Wet AMD and Medication: American Journal of Managed Care. (2019). “Review of Neovascular Age-Related Macular Degeneration Treatment Options.” ajmc.com/journals/supplement/2019/mitigate-blindness-neovascular-age-related-macular-degeneration/review-of-neovascular-agerelated-macular-degeneration-treatment-options?p=2
- Avastin: Ophthalmology. (2016). “Five-Year Outcomes with Anti-Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration: The Comparison of Age-Related Macular Degeneration Treatments Trials.” ncbi.nlm.nih.gov/pubmed/27156698
- AMD and Off-Label Meds: American Academy of Ophthalmology. (2019). “What Is Avastin?” aao.org/eye-health/drugs/avastin
- Wet AMD and Anti-VEGF: American Academy of Ophthalmology. (2019). “How Is Wet AMD Diagnosed and Treated?” aao.org/eye-health/diseases/amd-treatment
- AMD and Vitamins: Mayo Clinic. (n.d.) “Wet Macular Degeneration Diagnosis.” mayoclinic.org/diseases-conditions/wet-macular-degeneration/diagnosis-treatment/drc-20351113
- Wet AMD and Progression: Community Eye Health. (2014). “Age-Related Macular Degeneration.” ncbi.nlm.nih.gov/pmc/articles/PMC4322741/
- Wet AMD and HOME Study: Investigative Ophthalmology & Visual Science. (2014). “The Home Monitoring of the Eye (HOME) Study: Potential implication of Findings on Management of Intermediate AMD Patients.” iovs.arvojournals.org/article.aspx?articleid=2268452
- Wet AMD and Future Treatment: BrightFocus Foundation. (2019). “Update on the Age-Related Macular Degeneration Drug Pipeline.” brightfocus.org/macular/article/update-on-the-age-related-macular-degeneration-drug-pipeline