Wet Macular Degeneration – Diagnosis and Treatment
Diagnosis
Doctors look for signs of macular degeneration through several steps. They usually start by discussing the patient’s medical background and any family history of age-related macular degeneration (AMD).
Understanding risk factors, such as heredity and cardiovascular disease, helps guide the examination. A comprehensive eye exam is essential. The doctor uses special drops to widen the pupils and examines the back of the eye.
The doctor searches for yellow deposits called drusen beneath the retina. Drusen are a key indicator of early and intermediate stages of AMD. Finding drusen signals a higher risk for progression to late AMD or more severe vision loss.
Healthcare providers often use an Amsler grid to track changes in central vision. This simple test helps detect areas where straight lines look wavy, faded, or broken. These changes can signal central vision problems and early macular issues.
Table: Common Diagnostic Tools for Macular Degeneration
| Test Name | What It Identifies | Why It’s Used |
|---|---|---|
| Retinal Exam | Drusen, retinal condition | Early/advanced changes |
| Amsler Grid | Visual distortion, central vision loss | Monitors symptoms |
| Fluorescein Angiography | Leaking blood vessels, fluid buildup | Wet AMD confirmation |
| Indocyanine Green Angiography | Deep retina blood vessel issues | Hidden or complex cases |
| Optical Coherence Tomography | Retinal swelling/thinning, drusen layers | Imaging and monitoring |
| OCT Angiography | Blood vessel changes, fluid accumulation | Detects choroidal neovascularization |
Fluorescein angiography highlights leaking or abnormal blood vessels, which are common in wet AMD. Indocyanine green angiography shows deeper layers and confirms findings from other tests.
Optical coherence tomography (OCT) gives a detailed picture of the retinaโs thickness, structure, and any fluid or swelling. This scan helps catch minor changes and monitor how treatments work for both dry and wet macular degeneration.
People with risk factors such as a family history of AMD, cardiovascular disease, or previous retinal issues should have regular eye exams. Early detection with these diagnostic tools helps protect central vision.
If someone notices blurred or distorted vision, especially when reading or recognizing faces, they should get checked for this eye condition.
Treatment
Approaches With Medicine
Doctors often use anti-VEGF drugs as the first treatment. These medicines slow the growth of abnormal blood vessels in the eye.
They work by blocking signals called vascular endothelial growth factor (VEGF), which the body sends to create new blood vessels. Blocking these signals helps prevent swelling and bleeding under the retina.
Examples of anti-VEGF medications (used under prescription):
| Medicine Name |
|---|
| Bevacizumab |
| Ranibizumab |
| Aflibercept |
| Brolucizumab |
| Faricimab-svoa |
Doctors inject these medicines into the eye. This is usually done every 4 to 6 weeks.
Some people may notice vision improvement as the abnormal vessels shrink and fluid under the retina decreases. Treatments can slow eyesight loss and may improve vision if started early.
The shots carry some risks, including bleeding in the eye, higher eye pressure, infection, swelling, retina detachment, and irritation.
Other Medical Procedures
Photodynamic therapy involves two steps. First, a doctor injects a light-activated drug used in photodynamic therapy into the arm. This drug travels to the blood vessels in the eye. Next, the doctor shines a special laser on the vessels.
The light activates the medicine and causes problem vessels to close. This helps stop leaks and slow vision loss.
Sometimes, this laser treatment needs to be repeated. After photodynamic therapy, patients should avoid sunlight and bright lights for a few days to protect their skin.
Photocoagulation uses a strong laser to seal leaking blood vessels under the macula. Sealing these vessels helps stop bleeding and can slow further damage.
However, the laser might leave a scar that causes a blind spot. Few people with wet macular degeneration get this treatment, especially if vessels are in the center of vision.
Low vision rehabilitation helps people adapt if their central vision is reduced. With this support, people learn new ways to complete daily tasks.
Low vision specialists, occupational therapists, and eye doctors can be part of the care team. They may suggest different tools or techniques to help people read, recognize faces, and stay independent.
Daily Habits and At-Home Tips
Supplementing with Key Vitamins
Nutritional supplements may help reduce the risk of further vision loss for people at certain stages of macular degeneration. Doctors often recommend a specific combination of vitamins and minerals based on the AREDS2 formula.
This blend supports eye health and slows changes that can lead to vision loss.
The following table shows the usual amounts found in the AREDS2 blend:
| Nutrient | Amount in AREDS2 Supplement |
|---|---|
| Vitamin C | 500 mg |
| Vitamin E | 400 IU |
| Lutein | 10 mg |
| Zeaxanthin | 2 mg |
| Zinc (as zinc oxide) | 80 mg |
| Copper (as cupric oxide) | 2 mg |
Doctors might recommend these supplements for people with intermediate or later stages of the disease. These nutrients help by reducing harm from free radicals and supporting the cells in the eye.
- Lutein and Zeaxanthin: These antioxidants are found in dark, leafy vegetables like spinach and kale. They collect in the eye and may lower damage caused by light.
- Zinc: This mineral supports the health of nerve cells in the eye. It is found in meats, dairy, and whole grains.
- Vitamin C and E: These vitamins also work as antioxidants. They help protect eye cells from damage that can come from aging or poor nutrition.
People should not replace a healthy diet with supplements, but these vitamins may help those at risk for vision changes. It is important to speak with a health professional before starting any new high-dose vitamin or mineral supplement.
Some people with certain conditions or who smoke may need a different mix of nutrients.
Along with supplements, managing other health factors is important. Quitting smoking, eating a balanced diet with lots of vegetables and healthy fats, keeping a healthy weight, exercising, and following up with eye exams help maintain eye health.
Coping and Support
Adapting to vision changes from macular degeneration can be challenging. Using the right tools and support makes tasks easier and protects independence.
Keeping eyeglass prescriptions current is essential. Up-to-date glasses improve clarity for daily tasks.
If standard glasses are not enough, a low vision specialist can recommend other options. Magnification tools help with activities like reading or sewing.
These devices range from hand-held magnifying lenses to glasses with built-in magnifiers. Some people use closed-circuit television systems, which project printed materials in large text on a screen.
Computers and tablets can be adjusted for easier use. Increasing font sizes and contrast settings makes screens more readable.
Many devices now offer speech output or voice-controlled features. These options reduce dependence on vision for communication and information access.
Assistive devices and technology for daily activities
| Tool or Device | Purpose |
|---|---|
| Hand-held magnifiers | Reading, viewing small objects |
| Glasses with magnifying lenses | Reading, close-up tasks |
| Closed-circuit television systems | Projecting text/materials in large font |
| Large-print books or high-contrast screens | Easier reading |
| Audiobooks and voice interfaces | Accessing information by listening |
| Clocks, phones, and radios with large numbers | Managing daily tasks |
| Voice recognition on tablets/smartphones | Controlling devices by speech |
Improving lighting at home also helps with many activities. Brighter rooms make it easier to read, cook, or move around safely. Small changes, such as adding brighter bulbs or extra lamps, can make a big difference.
Driving with vision loss is a serious concern. Only a doctor can give safe advice about driving. Sometimes, it is best to rely on family, friends, ride-sharing, or public transportation, especially at night or in bad weather.
Strong emotional support is just as important as physical changes. Adjusting to life with macular degeneration can bring feelings like sadness, anger, or anxiety.
A professional counselor or support group can provide comfort and practical advice. Spending time with supportive friends and family members also helps.
Getting Ready for Your Eye Visit
Steps You Can Take Before the Visit
It is important to prepare for an eye appointment, especially when checking for macular degeneration. Here are ways to get ready:
Call Ahead: When scheduling the exam, ask if there is anything specific to do before coming in, such as not wearing contact lenses or skipping certain eye drops.
Write Down Symptoms: List any changes in vision or other symptoms, even if they seem minor.
Make a Medication List: Bring a list of all medicines, vitamins, and supplements being taken, including dosage amounts.
Bring Support: Arrange for a friend or family member to join the visit. After a dilated eye exam, eyesight can be blurry or sensitive, so driving may not be safe.
- Prepare Questions: Make a list of things to ask the eye care specialist. Some examples include:
| Possible Questions |
|---|
| Is my condition wet or dry macular degeneration? |
| How advanced is the disease? |
| Is driving safe for me? |
| What treatments are available? |
| Will supplements help my vision? |
| How should I track any changes in my vision? |
| What signs mean I should call your office? |
| Are there low vision aids that would be helpful? |
| What lifestyle changes do you suggest for eye health? |
What the Eye Doctor Might Ask
During the appointment, the eye care professional will ask about your symptoms and medical history. This helps them understand the problem better.
Typical questions include:
- When did you notice changes in your vision?
- Is the issue in one eye or both eyes?
- Do you have trouble seeing up close, far away, or both?
- Do you smoke now, or have you smoked in the past? If so, how much and for how long?
- What is your usual diet?
- Do you have other health problems like diabetes, high cholesterol, or high blood pressure?
- Does anyone in your family have a history of macular degeneration?
The eye doctor often performs a dilated eye exam to check the back of your eyes closely. Regular eye exams help detect changes early.
