Age-related macular degeneration (AMD) stands as one of the leading causes of irreversible vision loss globally, affecting millions of individuals, particularly those aged 50 and older. Among its two main forms, wet AMD presents a particularly challenging scenario due to the rapid progression of vision impairment caused by the abnormal growth of blood vessels beneath the macula, the central part of the retina. The advent of various treatment modalities has significantly transformed the management of wet AMD, offering hope and improved outcomes for patients. However, understanding the intricacies, benefits, and potential risks associated with each treatment option is essential for both patients and healthcare providers. In this detailed guide, we will explore the mechanisms of action, benefits, and risks of wet AMD treatments, empowering readers to make informed decisions about their ocular health.

Age-related macular degeneration primarily affects the macula, a tiny but vital area near the center of the retina responsible for detailed central vision. In wet AMD, abnormal blood vessels, termed choroidal neovascularization (CNV), grow beneath the macula. These vessels are fragile and prone to leakage, leading to the accumulation of fluid, blood, and protein in the macular region. As a result, the macula becomes distorted and damaged, causing central vision loss, which can progress rapidly if left untreated. Risk factors for wet AMD include advancing age, genetic predisposition, smoking, obesity, and cardiovascular diseases.

1. Anti-VEGF Therapy:
   • Mechanism: Anti-VEGF drugs, such as ranibizumab, aflibercept, and bevacizumab, work by blocking the activity of vascular endothelial growth factor (VEGF), a protein that promotes the growth of abnormal blood vessels. By inhibiting VEGF, these medications reduce vessel leakage, inhibit further growth, and help restore retinal health.
   • Benefits: Anti-VEGF therapy has revolutionized the treatment of wet AMD, offering substantial improvements in visual acuity and quality of life for many patients. Clinical trials have demonstrated its efficacy in stabilizing or even improving vision in a significant proportion of cases.
   • Risks: While generally well-tolerated, anti-VEGF injections carry certain risks, including the potential for intraocular inflammation, retinal detachment, endophthalmitis (severe eye infection), increased intraocular pressure, and rare instances of stroke or heart attack.
2. Photodynamic Therapy (PDT):
   • Mechanism: Photodynamic therapy involves the administration of a light-sensitive medication, verteporfin, followed by the application of a non-thermal laser to activate the drug selectively. When activated by light, verteporfin causes damage to the abnormal blood vessels while sparing healthy retinal tissue.
   • Benefits: PDT can be beneficial for certain subtypes of wet AMD, particularly cases involving predominantly classic CNV lesions. It can help reduce leakage from abnormal vessels and slow disease progression.
   • Risks: Common side effects of PDT include transient visual disturbances, photosensitivity, and ocular discomfort. However, PDT is less commonly utilized today due to the widespread adoption of anti-VEGF therapy, which has demonstrated superior efficacy in many cases.
3. Laser Therapy:
   • Mechanism: Laser therapy, also known as photocoagulation, aims to seal leaking blood vessels and destroy abnormal tissue using a focused beam of light. This approach helps to reduce fluid leakage, stabilize vision, and prevent further damage to the macula.
   • Benefits: Laser therapy may be considered for specific subtypes of wet AMD, such as extrafoveal or juxtafoveal CNV lesions. It can be particularly effective in cases where anti-VEGF therapy is contraindicated or ineffective.
   • Risks: Laser therapy carries the risk of causing permanent damage to the retina, including scarring, loss of peripheral vision, and the formation of new blood vessels (choroidal neovascularization).
4. Surgical Intervention:
   • Mechanism: In cases of advanced or refractory wet AMD, surgical procedures such as vitrectomy or retinal translocation may be considered. These interventions aim to remove scar tissue, reposition the macula, or address complications such as retinal detachment.
   • Benefits: Surgical intervention may be necessary for individuals with severe vision loss or complications of wet AMD that cannot be managed with other treatment modalities.
   • Risks: Surgical procedures carry inherent risks, including infection, hemorrhage, retinal detachment, cataract formation, and the potential for worsened vision or loss of the eye in rare cases.

The management of wet AMD requires a personalized approach tailored to the individual patient’s needs, disease characteristics, and treatment goals. While anti-VEGF therapy remains the cornerstone of treatment for many patients, alternative modalities such as PDT, laser therapy, and surgical intervention may be warranted in specific clinical scenarios. By collaborating closely with their ophthalmologists or retina specialists, patients can make informed decisions about their treatment options, weighing the potential benefits against the associated risks. Additionally, ongoing research and technological advancements continue to enhance our understanding of wet AMD and refine therapeutic strategies, offering hope for improved outcomes and vision preservation in the future.

World Eye Care Foundation’s eyecare.live brings you the latest information from various industry sources and experts in eye health and vision care. Please consult with your eye care provider for more general information and specific eye conditions. We do not provide any medical advice, suggestions or recommendations in any health conditions.