Treatment of Wet Macular Degeneration

Treatment of Wet Macular Degeneration © 2019 American Academy of Ophthalmology

Treatment of Wet Macular Degeneration



The main goal in the Treatment of Wet Macular Degeneration is to stop the growth of abnormal blood vessel or CNV.

Wet macular degeneration treatment includes medical and surgical treatments. Medical treatments include antioxidants, laser therapy, photodynamic therapy and FDA-approved Anti-VEGF medications such as Eylea, Lucentis, Macugen and Visudyne.



1- Laser Photocoagulation

Application of hot laser spots to burn and seal CNV or to slow down the progression of the new abnormal blood vessels. It will also inhibit the leak of these new blood vessels. Laser procedure for wet macular degeneration treatment is indicated for CNV away from the fovea of about 500 microns.

The goal of laser treatment is to prevent or decrease the risk of additional severe loss of vision from AMD. After laser treatment the vision will not improved and sometimes it may even become worse because those laser burns will leave scars in retina which will appear as blind spots or Scotoma on visual field.

However, loss of vision after laser treatment is generally less severe than the eventual loss of vision from Wet AMD if laser is not done. In some cases vision will be improved and some visual distortion will disappear after laser application.



Some patients after laser treatment will continue to loss vision due to recurrent neovascular AMD or persistent one which was not regressed totally with laser and that is why every patients who had laser treatment for wet AMD should follow-up regularly (or in case they notice new symptoms after laser treatment) to the clinic for eye examination and FFA to make sure that there is no recurrent or persistent AMD.

Laser application should not be given for patients who have neovascularization under his fovea. Fovea is the center of the macula which is responsible for central vision and for those patients we use photo dynamic therapy or Ant-VEGF injection.

A new laser can be used to treat CNV under the fovea. This laser is called Laser micropulse. It want cause thermal damage to the fovea so it can be used safely for Foveal CNV.



2- Photodynamic Therapy

In Wet macular degeneration treatment with PDT, we use a photosensitive drug called verteporfin or Visudyne which is injected intravenously.

This drug is activated by illumination with non-thermal infrared diode or cold laser with a wavelength of 689nm. This drug is taken by abnormal blood vessels in the back of the eye.

With the application of this low energy laser to the abnormal blood vessels, the drug will be activated and it will induce inflammation.

This inflammation will lead to seal of the abnormal blood vessels. This treatment does not produce a blind spot on the retina because it will only affect the abnormal blood vessels with no scar formation.



3- Intravitreal Injections

Intravitreal injections of anti-VEGF medications. VEGF stands for vascular endothelial growth factor.

In wet macular degeneration, the main cause of new blood vessels formation is VEGF, which will form abnormal blood vessels that bleed and leak easily. New medications are made to act against these growth factors and these medications are called Anti-VEGF. Read more about Anti-VEGF Injections.


4- Topical  Anti-VEGF

Squalamine is a small anti-angiogenic aminosterol molecule that inhibits multiple growth factors. Read more about Topical Squalamine Ophthalmic Solution.



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