From the Guidelines
Wet age-related macular degeneration (AMD) is a leading cause of severe vision impairment among older adults, characterized by the growth of abnormal blood vessels under the macula, leading to vision loss.
Key Characteristics
- Neovascularization: The growth of new, fragile blood vessels under the macula, which can leak fluid and cause vision loss 1.
- Vision Loss: Wet AMD can cause rapid and severe vision loss, with patients reporting a substantial decline in quality of life and increased need for assistance with daily activities 1.
- Risk Factors: Cigarette smoking is a significant risk factor for progression of AMD, and smoking-cessation counseling may help reduce this risk 1.
Treatment Options
- Anti-VEGF Treatment: Intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors are a common and effective treatment for wet AMD, reducing legal blindness and visual impairment 1.
- Photodynamic Therapy: A treatment combining verteporfin and low-level laser light, which can help reduce vision loss in patients with wet AMD 1.
- Laser Photocoagulation: An older treatment for wet AMD, which is no longer in common use due to the risk of blind spots in the treatment area 1.
Importance of Early Detection
- Comprehensive Eye Examination: A comprehensive eye examination is essential for early detection and treatment of wet AMD, as early symptoms may be subtle and patients may not notice significant vision loss until the disease is advanced 1.
From the Research
Definition and Characteristics of Wet Age-Related Macular Degeneration (AMD)
- Wet AMD is a form of age-related macular degeneration characterized by the formation of subretinal choroidal neovascularization, leading to sudden and severe visual loss 2.
- It is also known as exudative age-related macular degeneration, and is the leading cause of blindness in individuals over the age of 65 years 3.
- The disease is caused by the growth of abnormal blood vessels under the macula, which can lead to edema, hemorrhage, and scarring of the macula, resulting in metamorphopsia and vision loss 3.
Pathophysiology of Wet AMD
- The vascular endothelial growth factor (VEGF) plays a key role in the pathogenesis of wet AMD, and its inhibition is a key component of treatment 2, 4, 5.
- The formation of choroidal neovascularization is a hallmark of wet AMD, and is driven by the production of VEGF 3, 6.
- Defective immune modulation in the eye is also thought to play a role in the development of wet AMD 6.
Treatment of Wet AMD
- The current standard treatment for wet AMD is intravitreal injections of anti-VEGF medications, which have been shown to improve visual outcomes and reduce the risk of vision loss 2, 4, 5, 3.
- Treatment strategies have evolved to include individualized regimens, such as "pro re nata" and "treat and extend", which aim to reduce the frequency of injections while maintaining therapeutic efficacy 2.
- Novel and investigational therapies, including bispecific antibodies, biosimilars, small molecules, gene therapy, and long-acting drug delivery strategies, are also being developed to treat wet AMD 4.