Management of Wet Age-Related Macular Degeneration - Episode 2
Roger A. Goldberg, MD, MBA, and Lloyd Clark, MD, provide insight on initial symptoms patients typically present with in wet AMD.
John W. Kitchens, MD: Roger, both Dante and Lloyd mentioned this wet age-related or exudative age-related macular degeneration. Can you describe that to us?
Roger A. Goldberg, MD, MBA: Yes. As Lloyd mentioned, there are 2 advanced forms of age-related macular degeneration. There is the advanced dry form, which we call geographic atrophy, not a topic for today, and the other advanced form, which we call wet or neovascular, or sometimes the word exudative, age-related macular degeneration. All those terms are synonymous—wet, neovascular and exudative—in this setting. What it means is, you can get these blood vessels from underneath the retina that start to grow, and those blood vessels can leak fluid and can bleed. That fluid or blood, if left untreated or not caught early, used to be the leading cause of vision loss in the United States. We’ll get into it in a bit here, but we have treatments now for the wet form of macular degeneration, which has saved, frankly, millions of people from going blind from the wet form of macular degeneration and prevented vision loss. Basically, the wet form is these blood vessels growing underneath the retina.
The way I explain it to patients, which is generally helpful for an audience, is the macula and the retina that you’re born with are like freshly paved cement. When you get dry macular degeneration, you get some cracks in the cement, and again, that tends to develop with time, as Dante mentioned, it’s an age-related process. If you were to protect that sidewalk from any rainfall or windstorms, or life, maybe you could delay those cracks from developing eventually. But by and large, old sidewalks will start to develop some cracks. Then eventually, some grass or weeds start to grow up through those cracks, and that’s the wet form, those blood vessels growing up through the cracks in the sidewalk. Visually, that’s a nice way to understand it.
John W. Kitchens, MD: Roger, does everybody who develops macular degeneration go on to form the wet form of the disease?
Roger A. Goldberg, MD, MBA: The short answer is no, only about 10% of patients with macular degeneration overall develop this advanced, wet form of macular degeneration. One question you have might be, “Well, if everybody were to live to 120 years old, might they all develop the wet form?” Maybe they all would eventually develop some degree of wet macular degeneration, but as of now, it’s only about 10% of patients who are developing the wet form.
John W. Kitchens, MD: Dante, a lot of our listeners are going to be primary care doctors. What should the symptoms of wet macular degeneration be, that they’re really listening for?
Dante J. Pieramici, MD: There’s a whole gamut of potential symptoms. There may be no symptoms, and a patient has wet macular degeneration. In an elderly patient who has a strong family history of macular degeneration, that may be enough to send them to make sure they’re seeing a retina specialist or a general ophthalmologist. The common things that people will complain of are mostly the things that involve the central vision, things like reading or seeing faces. Patients will be having trouble reading, they may see distortion, there may be blind spots in their vision, or they just may have blurriness. For the most part, if it’s the dry form of the disease, which most patients have, as Roger mentioned, only 10% or 20% of patients develop the wet, it can be a very slow and progressive decrease in visual acuity.
On the other hand, when patients develop the wet disease, it could be a much more abrupt change, and they may wake up one day and there’s a blind spot in the vision or they have what’s called metamorphopsia, where things look distorted. They look at the blinds, oftentimes people talk about the blinds in their house, and they look at them and they’re not straight anymore, they’re distorted. Faces look unusual, they can’t read anymore. These are the types of things to think about. This is different than say a retinal detachment, where patients lose the peripheral vision. These are central vision problems in primarily reading-like tasks that the patients are going to be complaining of.
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Transcript Edited for Clarity