Wet Age-Related Macular Degeneration

Wet age-related macular degeneration usually shows up suddenly in one eye. The main warning signs are:

• Distorted straight lines (metamorphopsia) — door frames, blinds, or letters on a page look wavy, bent, or pinched. This is often the first sign ³.
• A new dark, gray, or blank spot (central scotoma) right in the middle of your vision.
• Sudden blurry central vision when you read or look at faces.
• Colors look dimmer or less bright in one eye than the other.
• Trouble seeing in dim light or needing much brighter lights to read.

Wet AMD is not painful. The eye looks normal from the outside. Side (peripheral) vision usually stays normal — only the central vision is affected. If you have AMD or drusen in one eye, an Amsler grid at home can help you catch new distortion early ⁶.

Wet AMD is the advanced, neovascular form of age-related macular degeneration. It almost always starts as dry AMD. Over years, drusen and pigment changes build up under the macula. In some eyes, the body sends a signal called VEGF (vascular endothelial growth factor) that tells abnormal new blood vessels to grow from the choroid up into the macula. These vessels are fragile and leaky, which is why the wet form causes fast vision loss ⁷.

Things that raise your risk:

• Age 55 and older — risk rises sharply after age 70.
• Smoking — the strongest changeable risk factor. Smokers are 2-4 times more likely to develop AMD.
• Family history of macular degeneration — genes like CFH and ARMS2 raise risk.
• White race / European ancestry — wet AMD is more common in people of European descent.
• Light-colored eyes (less protective pigment).
• Drusen or dry AMD in either eye.
• Heart disease, high blood pressure, and high body weight.
• Wet AMD in the other eye — risk in the second eye is much higher.
• A diet low in leafy greens and fish and high in saturated fat.

Wet AMD is almost always treated with anti-VEGF eye injections. These are shots into the white of the eye that block the VEGF signal, so the abnormal blood vessels stop leaking and shrink down. Anti-VEGF is the first-line treatment, and it is one of the most effective treatments in modern eye care ⁴.

• Ranibizumab (Lucentis) — the first anti-VEGF drug approved for wet AMD.
• Aflibercept (Eylea, Eylea HD) — a common longer-acting option.
• Bevacizumab (Avastin) — used off-label; works as well as the others in studies and is much cheaper.
• Faricimab (Vabysmo) — newer drug that blocks two pathways and can give longer time between shots ⁸.
• Brolucizumab (Beovu) — another option for some patients.

How injections work in practice:

• Shots are given every 4-12 weeks, depending on the drug and your response.
• The eye is numbed and cleaned. The shot takes seconds and most people feel a quick pinch or pressure.
• Most people stay on injections for years. Many doctors use a "treat-and-extend" plan, slowly stretching out the time between shots as long as the macula stays dry on OCT imaging. Researchers are also working on longer-acting drug delivery options and new therapies for neovascular macular degeneration that may stretch the schedule further ⁹.

Other treatments used in some cases:

• Photodynamic therapy (PDT) — a light-activated drug; used today mainly for specific subtypes.
• Laser photocoagulation — rarely used now for wet AMD, since anti-VEGF works better.

Wet AMD changes the way you read, drive, and see faces, but most people keep useful vision with treatment. A few things that help day to day:

• Use an Amsler grid at home. Check each eye on its own, once a day or every few days. If lines that were straight start to look wavy, call your eye doctor the same day ¹⁰.
• Do not miss your intravitreal injection visits. Nonadherence to intravitreal injection therapy is one of the biggest reasons people lose vision from neovascular macular degeneration ¹¹.
• Ask about AREDS2 vitamins. A specific vitamin and mineral mix can lower the risk of dry AMD getting worse, especially for the other eye.
• Stop smoking. Quitting slows the disease in both eyes.
• Use bright, even light for reading, and large-print books, magnifiers, or screen-reader apps if you need them.
• Ask about a low-vision exam. A low-vision specialist can match you with tools (special glasses, electronic magnifiers, audiobooks) that make daily tasks easier.
• Eat for eye health. A diet rich in leafy greens, colorful vegetables, and fatty fish supports the macula.