Wet Age-Related Macular Degeneration (Wet AMD)

Wet age-related macular degeneration (wet AMD) is a serious eye condition where abnormal blood vessels grow beneath the retina and leak fluid or blood into the macula. Though less common than dry AMD, wet AMD progresses much faster and is responsible for most severe vision loss from macular degeneration. The good news: effective treatments can preserve and sometimes improve vision.

What Happens in Wet AMD

In wet AMD (also called neovascular or exudative AMD):

1. Abnormal blood vessels grow under the retina (choroidal neovascularization)
2. These vessels are fragile and leaky
3. Fluid and blood accumulate under and within the retina
4. The macula swells and becomes damaged
5. Central vision deteriorates rapidly if untreated

This differs from dry AMD, which involves gradual deterioration without fluid.

Symptoms

Warning Signs

Common Symptoms

• Distorted vision (metamorphopsia)—most characteristic
• Straight lines appear wavy or crooked
• Central vision loss
• Difficulty reading
• Difficulty recognizing faces
• Need for brighter light
• Decreased color intensity

Risk Factors

Same as dry AMD, plus:

• Having dry AMD (wet develops from dry in most cases)
• Wet AMD in one eye significantly increases risk in fellow eye
• Larger drusen
• More extensive pigment changes
• Smoking (most important modifiable factor)
• Genetic variants (CFH, ARMS2)

Diagnosis

Comprehensive Examination

• Visual acuity testing—often significantly decreased
• Amsler grid—shows distortion
• Dilated fundus exam—may show hemorrhage, fluid, exudates

Essential Imaging

OCT (Optical Coherence Tomography)

• Most important diagnostic test
• Shows fluid under/within retina
• Detects abnormal vessels (OCTA)
• Monitors treatment response
• Guides treatment decisions

Fluorescein Angiography

• Dye injected into arm vein
• Photos show leaking vessels
• Defines type and location of neovascularization
• May not be needed if OCT diagnostic

OCT Angiography (OCT-A)

• Non-invasive imaging of blood vessels
• No dye needed
• Shows choroidal neovascularization

Treatment

Anti-VEGF Injections

Anti-VEGF (vascular endothelial growth factor) medications are the standard of care and have revolutionized wet AMD treatment.

How They Work

• Block the signal that causes abnormal vessel growth
• Reduce leakage from vessels
• Can shrink abnormal vessels
• Allow fluid to reabsorb

Medications

• Ranibizumab (Lucentis)
• Aflibercept (Eylea)
• Bevacizumab (Avastin)—off-label but widely used
• Brolucizumab (Beovu)
• Faricimab (Vabysmo)—also targets Ang-2

The Injection

• Performed in office
• Eye numbed with drops
• Very small needle
• Takes seconds
• Most patients tolerate well
• Mild discomfort possible

Treatment Schedule

• Initial loading doses (usually monthly for 3 months)
• Then individualized: monthly, treat-and-extend, or as needed
• Most patients need ongoing treatment for years
• Stopping treatment can lead to recurrence

Other Treatments

Photodynamic Therapy (PDT)

• Uses light-activated medication
• Less common now due to anti-VEGF effectiveness
• May be used for certain subtypes or in combination

Laser Photocoagulation

• Rarely used for wet AMD
• May be option for lesions away from center
• Causes permanent scotoma

Treatment Outcomes

With anti-VEGF treatment:

• About 90% of patients stabilize or improve
• About 30-40% gain significant vision
• Treatment is ongoing—stopping can lead to recurrence
• Early treatment yields best results

Living with Wet AMD

The Treatment Journey

• Frequent monitoring visits (often monthly initially)
• Injections as needed (varies by patient)
• OCT imaging at most visits
• Lifelong management in most cases

Between Appointments

Amsler Grid Monitoring

• Check daily or every few days
• Report any new distortion immediately
• Can detect early recurrence

Lifestyle

• Stop smoking (most important)
• Eat leafy green vegetables
• Take AREDS2 vitamins (for other eye protection)
• Protect eyes from UV light
• Control blood pressure

Practical Adaptations

• Strong reading lights
• Magnification devices
• Large-print materials
• Screen magnification
• Audiobooks
• Low vision rehabilitation

Monitoring the Other Eye

If you have wet AMD in one eye:

• Fellow eye at high risk (about 40% develop wet AMD within 5 years)
• Regular examination of both eyes
• Daily Amsler grid monitoring
• Report any new symptoms in either eye
• Consider protective supplements

Frequently Asked Questions

Do the injections hurt?

Most patients report minimal discomfort. The eye is numbed with drops, and the actual injection takes only seconds. Some describe a pressure sensation or mild stinging. Post-injection, mild irritation and redness are common but temporary.

How long will I need injections?

Most patients require ongoing treatment, though frequency varies. Some need monthly injections indefinitely; others can be treated less frequently. A minority can eventually stop treatment while maintaining vision. Your doctor will tailor treatment to your response.

Will I get my vision back?

Many patients improve with treatment, and most stabilize. Complete restoration of vision lost before treatment is uncommon, but treatment can prevent further loss and often provides meaningful improvement. Earlier treatment typically means better outcomes.

Is the treatment covered by insurance?

Anti-VEGF injections are covered by most insurance including Medicare. Bevacizumab (Avastin) is less expensive but used off-label. Coverage details vary—check with your insurance provider.

What happens if I miss appointments?

Missing treatments can allow the disease to reactivate, potentially causing permanent damage. Try to keep all scheduled appointments. If you must miss, reschedule as soon as possible.

Can wet AMD convert back to dry?

Treatment can dry up the fluid, but the underlying condition remains. The abnormal vessels can become inactive but are usually still present. Stopping treatment can lead to reactivation in many cases.

What if treatment doesn't work?

If one anti-VEGF agent isn't effective, switching to another may help. Some patients are non-responders, but this is relatively uncommon. Your doctor may try different approaches.

Coping with Treatment

Managing Anxiety

• Injection anxiety is common and understandable
• Most patients say it's better than expected
• Anxiety often decreases after first few treatments
• Deep breathing and relaxation techniques help
• Some doctors offer anti-anxiety medication if needed

Support Resources

• Macular degeneration support groups
• Low vision rehabilitation services
• Counseling for vision-related anxiety
• Family support and education

References