Demystifying Wet AMD Treatment
So you’ve been diagnosed with wet age-related macular degeneration (or wet AMD), a frustrating condition that significantly affects your vision. You probably have a lot of questions. One of your first ones, we’re guessing, is: Can this disease be treated? After your doctor likely says yes, wet AMD is treatable (very treatable, in fact), you probably have a few more questions about the treatment itself. Stick with us—we asked two ophthalmologists specializing in the disease to answer 10 questions about wet AMD treatment that just might be on your mind.
What Wet AMD Treatment Is Most Common?
The short answer: anti-VEGF medication. Having nothing to do with vegetable hatred, these drugs work by blocking something called vascular endothelial growth factor (VEGF), a protein made in your cells that slows the growth of abnormal blood vessels. These abnormal vessels leak fluid or blood into your macula, the part of your retina in charge of central vision, making it difficult to see.
Will Treatment Help Me See Better?
In the best possible outcome, yes. “About a third of patients can expect improvement in vision,” says Jason Hsu, M.D., an attending surgeon at Wills Eye Hospital in Philadelphia. Research shows that after two years of anti-VEGF treatment, more than 95% of patients with wet AMD maintain their vision, and up to 40% experience improvement. But something you need to know about anti-VEGF drugs: They’re given via (painless, we promise!) injections into your eye.
Will I Just Need One Treatment?
No, sorry. Wet AMD is a chronic eye disease that can worsen significantly (to the point of vision loss in the center range of your eye), so you’ll need regular injections. “Unfortunately, treatment is ongoing,” says Rukhsana G. Mirza, M.D., associate professor of ophthalmology and medical education, specializing in diseases of the retina, at Feinberg School of Medicine at Northwestern Medicine in Chicago. Don't dodge it: Your vision will deteriorate rapidly without treatment.
So How Often Do I Need Injections?
This depends on a number of factors, including how advanced your wet AMD is and how your eye responds to treatment. Some patients need monthly injections indefinitely to manage their disease progression, says Dr. Hsu. Others can go four to even six months between treatments. “Usually, we start off doing monthly injections, then depending on the response as the swelling in the retina and the bleeding go away, often we’re able to gradually space them out,” he says. “It varies from doctor to doctor and patient to patient.”
Who Should I See for This Treatment?
Shopping for trendy eyeglasses is one thing. When it comes to serious eye diseases like wet AMD (hello, needle-in-eyeball) being treated by an ophthalmologist (a.k.a. an eye doc with an M.D.) is a must. Best of all would be seeing an ophthalmologist who specializes in retina diseases, says Dr. Hsu—these specialists understand the nuances of the disease. Not sure where to look? The American Society of Retina Specialists features a useful "find a retina specialist" tool. You can also get a referral to a retina specialist from your general ophthalmologist.
Does Treatment Always Work?
Usually, yes. However, the effectiveness/efficacy depends on what stage the disease is detected. Anti-VEGF drugs are the first-line treatment for wet AMD, so your doctor will likely have you start with these meds, selecting one based on your unique needs and insurance coverage. If for some reason it doesn’t work, eye docs have a few more tricks up their sleeves, including switching to a different anti-VEGF med, giving you a “drug holiday,” or combining different therapies. Ask your doctor about options: New drugs are in development and could be approved in the near future, Dr. Mirza says.
Do Anti-VEGF Injections Hurt?
You’ll be awake during the injection but you shouldn’t feel pain, say Dr. Mirza. (If you didn’t freak a little though, you wouldn’t be human.) Your doctor will numb your eye with an anesthetic, including an eye drop, then put betadine on your eye to decrease infection risk—it’s a form of soap, so it may sting a little. Generally the eye is numbed with an eye drop or topical anesthetic and then cleaned with betadine drops to decrease the risk of infection. You’ll likely feel slight pressure during the injection. After, you might have a sensation like there’s sand in your eye, but it should resolve within a day.
I'm Afraid of Needles. How Do I Deal?
First, anti-VEGF injections are so quick, they’ll be over before you know it. The syringe takes only a few seconds to empty. Second, you likely won’t see the needle—it’s injected from the side of your eye. Regardless, it’s important to share your fears with your doctor. Dr. Mirza's office provides stress balls, the arm of the chair to hold onto as tightly as you need to, light classical music, even technicians who hold your hand. But first and foremost: “We get through it as fast as possible,” she says.
Where Does the Injection Go in My Eye?
You might be wondering, does the injection go into my pupil? Or my cornea? Neither, says Dr. Mirza. “We inject it into the white part of the eye,” she explains (called the sclera). Some offices use a device that does the work of holding your eye open for you. Others, like where Dr. Hsu practices, have an assistant gently hold the eye open by hand. If you’re still not sold on the idea of injection, the good news is that new and exciting treatments are in development that could change the way the meds are delivered, Dr. Hsu says. At the end of the injection, your doctor will also put an antibiotic eye drop to prevent infection.
- Wet AMD Symptoms: Mayo Clinic Staff. (n.d.) “Wet Macular Degeneration.” mayoclinic.org/diseases-conditions/wet-macular-degeneration/symptoms-causes/syc-20351107
- Wet AMD Treatment Options: American Academy of Ophthalmology. (2019). “Anti-VEGF Treatments.” aao.org/eye-health/drugs/anti-vegf-treatments
- AREDS: National Eye Institute. (2019). “Nutritional Supplements for Age-Related Macular Degeneration.” nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration/nutritional-supplements-age-related-macular-degeneration
- Wet AMD and Injections: Journal of Ophthalmology. (2012). “Anti-VEGF Treatment Strategies for Wet AMD.” ncbi.nlm.nih.gov/pmc/articles/PMC3317200/
- Wet AMD and Treatment Success: 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
- Eye Injections: Royal National Institute of Blind People. (2019). “Anti-VEGF Treatment.” rnib.org.uk/eye-health/eye-conditions/anti-vegf-treatment