Wet Age-related Macular Degeneration
The eye works like a camera. It has two parts, a lens and a film. The film layer lines the back wall of the eye and is called the retina. The area of the retina responsible for the central vision is called the macula.
Age-related macular degeneration (AMD) refers to specific age-related changes in patients 50 years and older. Wet age-related macular degeneration is characterized by the formation of undesirable abnormal new blood vessels underneath the macula. These blood vessels have a tendency to leak which decreases the quality of vision. Furthermore, if left untreated, these blood vessels may form scar tissue which may lead to a permanent decrease in central vision.
Treatment for Wet AMD
Wet Macular Degeneration, or Wet AMD, comes in a spectrum from those who have a driving-level vision upon being diagnosed to others who are legally blind. The treatments available improve vision by 1-2 lines and maintain vision during the long term. Treatment results vary for each eye.
The treatments available are treatments, not a cure. This means that patients will continue to need treatments for many years. Treatments are typically initiated every 4 weeks. The eye is monitored for its response to the medication and the time interval between injections is adjusted appropriately.
All treatments for wet macular degeneration are administered by intravitreal injection. An intravitreal injection is a safe in-office procedure in which a medication is injected into the vitreous cavity of the eye. This can be performed in a manner that causes minimal discomfort to the patient. Intravitreal injections are the only method available for the effective treatment of macular degeneration.
What is The Goal of Wet AMD Treatment
- maximize vision in the affected eye
- prevent the development of wet AMD in the other eye
- early detection of wet AMD in the other eye should it occur
Expectations Following an Intravitreal Injection
Following an intravitreal injection:
- Patients will notice their vision is blurrier immediately following the procedure.
- Patients commonly see black spots that move when their eyes move (floaters) for 1-2 days following the procedure.
- Redness commonly occurs after the injection where the needle entered the eye and in some cases, the entire eye will become very red. The redness will resolve without additional treatment within 1-2 weeks and cause no permanent harm to the vision.
- The eye is typically sore after the injection, but usually feels much better by the following day.
- If the vision goes black immediately after the injection, this could be a sign that the eye pressure is too high. The vision will usually return on its own within a minute. However, this does require immediate attention from your doctor.
Patients who are experiencing a burning sensation immediately after the eye injection should make the staff aware.
Patients who experience a burning sensation after leaving the office may consider using preservative-free artificial tear every 1 hour as needed for discomfort. It is important they wash their hands with soap and water and avoid touching their eyelashes.
Risks Following an Intravitreal Injection
The main risk of the procedure is the development of an infection called endophthalmitis. Fortunately, the risk of this infection is very low, occurring in approximately 1 in 3000 injections.
The signs of infection are:
- eye pain
- sensitivity to light
- decreased vision
If infection occurs, it typically 3-5 days following the treatment, but may occur earlier or later. Patients with these symptoms need to contact their eye care specialist immediately. Patients can decrease their risk of developing an infection by avoiding rubbing, touching their eyes, or allowing water into their eyes for at least one week.
Most patients undergoing intravitreal injections find that the procedure is much more comfortable than anticipated and that the post-procedure discomfort is minimal.
What are the Steps That Patients Can Do to Help Slow Vision Loss?
Patients who have both eyes affected by wet AMD do not need to take eye vitamins. Patients with only one eye affected by wet AMD will benefit from taking eye vitamins. The Age-Related Eye Disease Study Number 2 (AREDS2) vitamin decreases the risk of losing vision from macular degeneration by 25%. This formulation is different from a multivitamin. Taking a multivitamin plus lutein/zeaxanthin does not contain the same contents as an AREDS2 vitamin. Patients who regularly take a multivitamin may take an AREDS2 in addition if recommended by their doctor.
Patients may incorporate green leafy vegetables, fish, and omega-3s to provide their retina with the nutrients needed to decrease the risk of macular degeneration worsening. Studies have also demonstrated that maintaining a healthy weight can be beneficial for macular degeneration. Utilizing polarized sunglasses outside when outside for extended periods of time can decrease the risk of retinal damage from sun exposure. Smoking increases the risk of macular degeneration worsening by 3 times compared to a non-smoker.
Discontinuing smoking decreases this risk by 50%. Smoking increases the risk of macular degeneration worsening by 3 times compared to a non-smoker.
Monitoring vision is recommended for patients who have one eye with dry macular degeneration. Monitoring with an Amsler grid dramatically decreases the risk of vision loss from this condition. New distortion or blurriness discovered on an Amsler grid may be a sign of wet macular degeneration. Early detection and treatment of wet AMD can significantly improve visual results with treatment.
Have routine eye exams. The Amsler grid should be used to check each eye individually at a reading distance. Patients are instructed to look at the black dot in the center of the grid paper. Patients who notice new distortion or missing lines may be experiencing a conversion to the wet form of macular degeneration. Patients should continue to follow-up with their Retina Specialist.
If Wet AMD has impacted your vision, the specialists at Retina Care of Tampa can help.
Many patients with wet AMD continue to see well during their lifetime and maintain their independence. Adhering to the treatment regimen and items we discussed will dramatically increase the risk of meeting this goal.
Patients should continue to follow up with the AMD specialists at Retina Care of Tampa at their next scheduled appointment.