Wet Macular Degeneration: Causes, Treatment, and Vision Care
Understanding Wet Macular Degeneration
Wet macular degeneration, also called neovascular or exudative AMD, is an advanced form of age-related macular degeneration (AMD). It affects the macula, the small central area of the retina responsible for sharp, detailed vision. The macula is what you use to read, drive, recognize faces, and see fine details.
In wet AMD, abnormal blood vessels grow beneath the retina. These vessels are fragile and leak blood, fluid, and fatty deposits into and under the retina. This leakage damages the macula and can lead to scarring that destroys central vision. Approximately 1.49 million Americans aged 40 and older live with vision-threatening AMD, which includes wet AMD (CDC VEHSS data, 2019).
Dry AMD is the more common form of the disease. It develops when small yellow deposits called drusen build up under the retina. The light-sensitive cells in the macula slowly break down over time. Dry AMD usually progresses gradually over years.
Wet AMD behaves differently. It can cause severe vision loss within weeks to months if not treated. Any stage of dry AMD can convert to wet AMD, sometimes without warning. This is why regular monitoring is so important for anyone diagnosed with dry AMD.
The process behind wet AMD is called choroidal neovascularization. As the eye ages, changes in the layers beneath the retina can reduce the flow of nutrients and oxygen. In response, the retina produces excessive amounts of a protein called vascular endothelial growth factor (VEGF).
High levels of VEGF signal the body to grow new blood vessels from the choroid, a layer of blood vessels beneath the retina. These new vessels are structurally weak. They leak blood and fluid into the retinal tissue, disrupting its delicate structure and causing rapid death of photoreceptor cells. Over time, this process leads to scarring and lasting central vision loss.
Who Is Affected and Risk Factors
Age is the strongest risk factor for wet AMD. The condition primarily affects people over 50, and the risk increases significantly with each decade of life. Approximately 200,000 new cases of wet AMD are diagnosed each year in North America (Genentech AMD Fact Sheet). The prevalence of wet AMD among Medicare Advantage enrollees was 1.2 to 1.3 percent from 2018 to 2021 (JAMA Ophthalmology, 2025).
Genetics play a significant role in AMD. People with a first-degree relative who has AMD face roughly 2.5 times the risk of developing the condition. Genetic factors are estimated to account for approximately 50 percent of AMD cases (NEI, 2023). Having dry AMD in one or both eyes is also a major risk factor for developing the wet form.
Several modifiable risk factors are associated with wet AMD. Smoking is one of the most significant, increasing risk by two to three times. Other health-related risk factors include:
- Cardiovascular disease and high blood pressure, which raise risk by approximately 1.5 times
- High cholesterol levels
- Obesity, which may double the risk of AMD progression
- Excessive ultraviolet light exposure without eye protection
Certain demographic characteristics are linked to higher wet AMD risk. People of Caucasian descent have a higher prevalence than other racial groups. Women are affected more frequently than men. People with light-colored eyes may also face increased risk due to less natural pigment protection in the retina.
Signs and Symptoms
Wet AMD often develops suddenly. The first noticeable symptom is usually a change in central vision. Straight lines may begin to appear wavy or bent. This distortion, known as metamorphopsia, is a hallmark of wet AMD and should prompt immediate evaluation by a retina specialist.
Other early warning signs include a dark or blank spot in the center of your vision, difficulty recognizing faces, and trouble reading even with glasses. Colors may appear less bright or vivid than usual.
Certain vision changes require urgent attention. See a retina specialist or go to the emergency room immediately if you experience any of the following:
- Sudden blurring or decrease in central vision
- Straight lines appearing wavy or distorted
- A new dark or blank area in your central vision
- Any rapid change in the quality of your vision
Because wet AMD can progress quickly, delaying evaluation even by a few days can result in additional vision loss. Patients already diagnosed with dry AMD should check their vision daily using an Amsler grid, a simple tool that helps detect subtle distortion. Any new distortion should be reported to a retina specialist right away.
Wet AMD often affects one eye first. When only one eye is involved, the other eye may compensate. This makes it harder to notice changes. This is another reason daily self-monitoring with an Amsler grid is important. Covering one eye at a time while looking at the grid can reveal distortion that might otherwise go unnoticed.
Diagnosis and Testing
Diagnosing wet AMD begins with a comprehensive dilated eye exam. During this exam, a retina specialist places drops in the eye to widen the pupil. This allows a detailed view of the retina and macula. The specialist looks for signs of abnormal blood vessels, fluid, blood, or scarring beneath the retina.
Optical coherence tomography (OCT) is a key imaging test for wet AMD. It uses light waves to create detailed cross-sectional images of the retina. OCT can reveal fluid beneath or within the retinal layers, swelling of the macula, and changes in retinal thickness. This test takes only a few minutes. It is also used regularly to monitor treatment response.
Fluorescein angiography helps map the abnormal blood vessels. A special dye is injected into a vein in the arm. As the dye circulates through the blood vessels in the eye, a camera captures images showing where the vessels are leaking. This test helps a retina specialist determine the location and extent of the neovascularization and guide treatment decisions.
OCT angiography (OCTA) is a newer imaging technique that can visualize blood flow in the retina without dye injection. It provides detailed maps of retinal and choroidal blood vessels. While not a replacement for fluorescein angiography in all cases, OCTA is useful for ongoing monitoring. It can detect abnormal vessel growth in its early stages.
Treatment Options
Anti-VEGF injections are the standard of care for wet AMD. These medications block vascular endothelial growth factor, the protein that drives abnormal blood vessel growth and leakage. By reducing VEGF levels, these treatments help shrink abnormal vessels, reduce fluid leakage, and slow further damage to the macula.
Anti-VEGF medications are delivered as intravitreal injections (injections directly into the vitreous, the gel-like substance inside the eye). Treatment typically begins with monthly injections called a loading phase. After that, the interval between injections may be extended based on how the eye responds. Treatment can stabilize vision in roughly 90 percent of patients and improve vision in about 30 percent (AAO, 2024).
Several anti-VEGF medications are used to treat wet AMD. Each has different properties and dosing schedules:
- Lucentis (ranibizumab): One of the first anti-VEGF treatments approved for wet AMD, typically given every four weeks
- Eylea (aflibercept): Commonly used, with dosing typically every four to eight weeks after an initial loading phase
- Eylea HD (high-dose aflibercept): A higher-dose formulation that allows extended dosing intervals of up to eight weeks or longer
- Vabysmo (faricimab): A bispecific antibody targeting both VEGF and angiopoietin-2, allowing many patients to extend dosing to every 16 weeks
- Beovu (brolucizumab): Dosed every eight to twelve weeks, though it carries a risk of retinal vasculitis (inflammation of retinal blood vessels)
- Avastin (bevacizumab): Used off-label for eye conditions. This medication is FDA-approved for cancer treatment but is widely used in retina care due to its effectiveness
The Susvimo port delivery system is a refillable implant surgically placed in the wall of the eye. It continuously releases ranibizumab into the vitreous over months, reducing the need for frequent injections. Patients typically require refills only about twice per year. This option may be suitable for patients who respond well to ranibizumab but want fewer office visits. A retina specialist can determine if this approach is appropriate.
While anti-VEGF injections are the primary treatment, some situations may call for other approaches. Photodynamic therapy (PDT) uses a light-activated drug injected into the bloodstream and then activated by a special laser directed at the abnormal vessels. Laser photocoagulation uses thermal laser energy to seal leaking blood vessels. These treatments are less commonly used today but may be considered in specific cases or combined with anti-VEGF therapy.
What to Expect
Intravitreal injections are performed in a retina specialist's office. The eye is numbed with anesthetic drops or a small injection of numbing medicine. The surface of the eye is cleaned with an antiseptic solution to reduce infection risk. The injection itself takes only a few seconds.
Most patients feel pressure during the injection, and some experience mild discomfort. Temporary blurred vision, mild redness, and a feeling of grittiness are common afterward. These effects usually resolve within a day or two.
Wet AMD requires ongoing treatment and monitoring. Most treatment plans begin with monthly injections for the first three months. After this loading phase, the retina specialist uses OCT imaging and clinical exams to assess the eye's response. Injection intervals may be extended gradually depending on the medication used and the individual response.
Some patients may eventually go several months between injections. Others may need more frequent treatment to keep the disease under control. Missing or delaying scheduled appointments can allow fluid to return and cause additional vision loss.
Wet AMD is a chronic condition that requires long-term management. With consistent treatment, many patients maintain useful central vision for years. However, the degree of improvement depends on how much damage occurred before treatment began. This is why early detection is so important. Vision that is lost to scarring before treatment starts typically cannot be recovered.
Living with Wet Macular Degeneration
An Amsler grid is a simple chart with a grid of straight lines and a dot in the center. Looking at the grid one eye at a time can help detect new distortion, wavy lines, or blank spots. Retina specialists recommend checking the Amsler grid daily. Any new changes should be reported to a retina specialist promptly, as they may indicate disease activity that needs treatment.
Even with treatment, some patients experience lasting changes to central vision. Low vision specialists can recommend tools and strategies to help maintain independence. Magnifying glasses, large-print materials, high-contrast settings on electronic devices, and audiobooks are commonly used aids. Task lighting and reducing glare in the home can also help with daily activities.
Certain lifestyle changes may help slow AMD progression and support overall eye health. Quitting smoking is one of the most impactful steps a person can take. Eating a diet rich in leafy green vegetables, fish, and other foods high in omega-3 fatty acids may be beneficial. Regular exercise, maintaining a healthy weight, and wearing sunglasses that block ultraviolet light are also recommended.
The Age-Related Eye Disease Study (AREDS2) found that a specific combination of vitamins and minerals can reduce the risk of advanced AMD progression in certain patients (NEI, 2013). A retina specialist can advise whether AREDS2 supplements are appropriate based on the stage and type of AMD.
When to See a Retina Specialist
Optometrists and general ophthalmologists often detect signs of AMD during routine eye exams. If wet AMD is suspected, they will refer the patient to a retina specialist for further evaluation and treatment. Retina specialists, also known as vitreoretinal surgeons, have advanced training in diagnosing and treating diseases of the retina and vitreous.
Patients diagnosed with wet AMD need regular follow-up visits with a retina specialist. These visits include imaging tests to check for fluid or new vessel growth. Keeping all scheduled appointments is essential, even when vision seems stable. Wet AMD can reactivate at any time, and early retreatment helps preserve vision. Patients who notice any sudden change in their vision between appointments should contact a retina specialist right away.
Questions and Answers
There is currently no way to eliminate wet AMD. However, anti-VEGF treatments can effectively manage the condition by reducing fluid leakage and slowing damage to the macula. With consistent treatment, many patients maintain stable vision for years. The goal of treatment is to control the disease and preserve as much vision as possible over the long term.
Wet AMD affects central vision, not peripheral (side) vision. Even in advanced cases, most patients retain some peripheral vision, which helps with mobility and orientation. With modern anti-VEGF treatment, the risk of severe central vision loss has decreased significantly compared to earlier decades. Early diagnosis and consistent treatment offer the best chance of preserving functional vision.
Most patients with wet AMD need ongoing treatment for years, and many require treatment indefinitely. The frequency of injections may decrease over time as a retina specialist determines the longest safe interval between treatments. Stopping treatment without medical guidance can lead to disease reactivation and additional vision loss. Treatment plans are individualized based on how each eye responds.
There is no certain way to prevent dry AMD from progressing to wet AMD. However, several steps may help reduce risk. These include not smoking, maintaining a healthy diet and weight, managing cardiovascular health, and taking AREDS2 supplements if recommended by a retina specialist. Daily monitoring with an Amsler grid is important for detecting early conversion so treatment can begin promptly.
Newer anti-VEGF medications have been developed to allow longer intervals between treatments. Vabysmo (faricimab) targets two pathways involved in wet AMD and has allowed many patients to extend dosing to every 12 to 16 weeks. Eylea HD (high-dose aflibercept) also supports extended dosing. The Susvimo port delivery system offers continuous drug release with refills roughly twice a year. Researchers are also studying gene therapy and other approaches that may further reduce treatment burden. A retina specialist can discuss which options may be most appropriate.