Without treatment, studies have shown that many people diagnosed with wet AMD will be functionally blind in 2 years. But there are treatments that can help slow the disease. In some cases, these treatments can reverse vision loss. These treatments include:
These newer, effective treatments target 1 or more of the family of proteins that stimulate growth of the leaky vessels in the eye. These treatments have been shown to stop wet AMD in many patients and, in some cases, reverse vision loss by reducing the growth of new blood vessels, decreasing leakage, and preventing bleeding. There are a few differences between anti-VEGF-A treatment and anti-angiogenic therapy, including how they work inside the eye. There also may be more or fewer injections required to impact your vision, depending on the treatment chosen by you and your retina specialist.
Anti-VEGF-A drugs target and block the glycoprotein VEGF-A. In wet AMD, VEGF-A is produced at higher than normal levels in the retina. Lowering VEGF-A with anti-VEGF-A drugs reduces its effects on retinal blood vessels, prompting a reduction in macular edema without risk of developing major eye conditions.
An additional protein, called Placental Growth Factor (PIGF), may play a role in wet AMD, but anti-VEGF-A treatment does not target this protein.
In addition to VEGF-A, anti-angiogenic treatments also block a protein called placental growth factor (PlGF) that may play a role in wet age-related macular degeneration (AMD). Targeting this additional protein may improve how the treatment impacts your vision. Ask your retina specialist about which treatment choice is best for you.
To deliver the anti-angiogenic and anti-VEGF-A drugs into the eye, an eye or retina doctor first numbs the eye surface and then injects the medication using a short, thin needle. This entire procedure takes only a few minutes and is not painful.
As the anti-angiogenic or anti-VEGF-A medication is absorbed into the tissues of the macula, it lowers the levels of VEGF-A that cause the leaky blood vessels.
As VEGF-A levels in the eye are reduced, the growth of the abnormal blood vessels is halted, and these vessels begin to break down and regress. With continued treatment, the abnormal fluid also dissipates.
Wet AMD is a chronic disease, and anti-angiogenic and anti-VEGF-A treatments are not a cure. However, with anti-angiogenic and anti-VEGF-A treatments, it is possible to control angiogenesis and the related swelling to gain or stabilize vision and prevent further damage to the macula. Your eye doctor can determine which treatment is best for you and how often it should be administered.
The injection may be slightly uncomfortable for some people, and you may have to wear an eye patch for a few hours afterward to protect your eye(s). You will likely need someone to come with you to your appointment to help you get around for a few hours after the injection.
Hello there – my name is Jack Smith. I'm 85. I have wet age-related macular degeneration, or wet AMD – and I'm doing just fine. This is my story...
I am originally from Glasgow in the UK. I met my wife Maggie at a dance – and we married in 1953 – so that's 60 years ago!...
We had four children and one on the way when we moved to Australia in 1965. We made our home in Blacktown, west of Sydney. I worked as a bread vendor – and played soccer in the midfield for Blacktown City...
When I retired from playing for the main team, I continued playing for the Blacktown Old Buffer's. My nickname was 'Twinkle Toes' because blokes in their 20's couldn't keep up with me!... I played the game until I was 76, when a ruptured quadriceps tendon forced me to hang up my boots. I still miss it.
I first noticed a few problems with my eyesight when I was in my late 60's. My central vision started to become blurry, but my peripheral vision was OK. It was a bit of a struggle to read, see fine detail, drive my car and recognise faces. I was getting the names of my grandchildren wrong because I couldn't see them clearly!
I was aware my father was nearly blind by the time he was in his late 60's. So I went to an ophthalmologist who diagnosed me with wet age related macular degeneration, or wet AMD. I was 69. That was 16 years ago and there was no treatment available at the time.
Although I never took my eyesight for granted, it wasn't until my vision was under threat that I really stopped and thought about how many great pleasures in my life depend on being able to see... Simple things like seeing my 13 grandchildren grow up, watching my beloved soccer on TV or live at the stadium – and of course driving my car...
But gradually, my problem began to get worse. I thought I might have to stop driving. Watching TV was difficult – and worst of all, I was having real trouble telling my grandkids apart.
Right about then, an ophthalmologist called and asked if I wanted to start treatment with a new product. I had nothing to lose and lots to gain, so I said 'yes', even when I was told the treatment involved having an injection in my eye.
In the first treatment, they anaesthetised my eyes, put a cover on them to stop me blinking and then injected the treatment. Naturally, I found it a bit scary.
The second time, I was fine. The only sensation I now feel when I go for treatment is the anaesthetic drops going in. There is no pain at all with the needle. There's an old saying, 'I'd rather have needles in my eyes that do this or that!' – but with anaesthetic, it's actually not bad at all. I still haven't been able to stop my feet kicking up though, which gives my nurse a big laugh. She says it's a natural reflex action. I wear a bandage on my eyes for an hour or two, then I'm good to go.
My son or daughter drives me to and from the clinic for each injection.
I now have regular treatment and it has made such a difference. I can carry on enjoying my loved ones and my soccer matches. Before, I was really worried about driving – but now I'm fine with it. I've got a conditional licence – so I can only drive up to 10 kilometres and I'm not allowed to drive at night – but that's fair enough...
I can see better now than I could four or five years ago. I don't need to use my glasses as much. I can read the newspaper where I couldn't before, but my eyes do get tired. Sometimes I resort to a hand-held magnifier. And most important – I can recognise my grandkids better!
I can see more detail now and Maggie gets me hang out the washing, so she's happy!... She reckons my driving's better too.
I'm glad I went on the treatment. It's a bit expensive, but it's worth it.
Overall, having wet AMD hasn't affected my life that much. I've always been a happy, positive fella and I think that's important when you have medical issues. My dodgy memory is concerning me more now than my macular degeneration! The other week I parked my car at the shopping centre and forgot where it was. At least when I finally found it, I was able to see it was mine!
Another benefit is that I no longer trip over my feet when Maggie and I go line-dancing twice a week at the Blacktown Workers Club and Dean Park Community Centre. Combined with daily stretching, a diet of good old porridge like I always had back home – and Maggie's ham hock soup, line dancing keeps me fit and healthy. I may be 85, but my toes are still twinkling.
This is one patient's experience and treatment experiences may differ from patient to patient.
Laser treatment aims to destroy the fragile, leaky blood vessels growing in the back of the eye. Limitations of this treatment are that it is appropriate in only a small percentage of people with wet AMD and the vessels can grow back. Laser treatment is not widely used anymore.
For PDT, a light-activated drug is injected into the arm and travels through the blood stream, including the new blood vessels in the eye. A light is shone into the eye to activate the drug, and the fragile, leaky blood vessels are destroyed. PDT can slow the progression of wet AMD but cannot stop vision loss or restore vision. In addition, patients may need to stay out of the sun for several days until the drug has passed through the body, results are often temporary, and patients may require multiple treatments. PDT is not appropriate for all types of wet AMD, so talk to your doctor to find out if PDT is a treatment option for you.
If you are undergoing any of these treatments or plan on having these treatments, this Discussion Guide will help you with questions you may have for your doctor.
“I’m glad I took time to learn the differences between the available treatments for wet age-related macular degeneration.”
Treating wet AMD can be intimidating for some, but there are groups of people who want to help.
Before undergoing laser treatment, patients often receive a topical anesthetic or injection adjacent to the eye to numb it and prevent it from moving during the procedure.
A laser is then targeted into the eye for several minutes, sealing up abnormal, leaking blood vessels in the retina with little or no pain and discouraging future growth.
Laser treatment may also damage nearby healthy tissues, causing immediate loss of some vision. The effects of laser treatment are permanent, though repeat treatments may be necessary to address newly grown damaged blood vessels.
A drug that reacts to light is injected into the arm to circulate in the bloodstream throughout the body.
Light from a cold laser is shone into the eye, activating the dye to seal off leaking, damaged blood vessels.
After treatment, patients must avoid exposure to direct sunlight or bright indoor light for several days until the drug evacuates the body. This is necessary because residual drug levels in the skin can be activated by these light sources.