“Wet” and “dry” macular degeneration differ but both cause vision loss
By Deborah Jeanne Sergeant
Age-related macular degeneration (AMD) may be wet or dry. The two types of macular degeneration typically occur in people older than 50 and it’s most common in those who are over 70.
The macula is in the center of the retina at the back of the eye. The macula allows people to see the details of things directly in front of them and is vital for tasks like reading, recognizing people visually and driving.
Raja Narayanan, ophthalmologist and retina and vitreous surgeon at UR Medicine Flaum Eye Institute, explained that wet AMD (W-AMD) refers to fluid accumulation and swelling at the back of the eye and sometimes bleeding.
“If there is no bleeding in the back, it’s dry macular degeneration,” Narayanan said.
W-AMD progresses more quickly and the swelling and bleeding can cause severe vision loss. Dry age-related macular degeneration (D-AMD) typically presents with less vision loss.
D-AMD patients tend to experience trouble with reading, as near vision is affected more.
“A dark spot in the front of the eye blocks reading ability,” Narayanan said. “If it progresses, they’ll have problems recognizing people at a distance and driving.”
Patients with W-AMD may report seeing wavy lines or crooked lines. That can interfere with working on a laptop or reading a book.
“We have a grid chart which has straight lines and ask patients to self-evaluate every week,” Narayanan said. “If they report seeing the lines turn wavy or crooked, they’re asked to report immediately.”
Both W-AMD and D-AMD may be treated. With W-AMD, treatments can improve vision. However, for D-AMD, providers can only stabilize patients to try to slow further damage. Without treating D-AMD, it quickly progresses in a year or two.
Taking eye supplement formulas and antioxidants were the only means of treating D-AMD until a few years ago.
“The other standard of care used to be laser, but they were not as effective at stopping the disease as injections,” Narayanan said. “We at Flaum have been looking at stem cell restoration therapy. It’s in the clinical trial stage. If we have positive outcomes in preclinical trials, we can start clinical trials in two years. Maybe in the future, we will have something for the wet form as well.”
At this point, the stem cell treatment is a surgical procedure done under the retina.
“So far, all treatments have been more like vision stabilization and we haven’t had any restoration treatment,” Narayanan said.
He anticipates that the soonest stem cell treatment would be available is three to five years if Flaum’s procedure proves successful.
“Macular degeneration is a tough disease but we are making progress,” Narayanan said. “There are newer drug delivery systems that are easier now. We have shots every month or every other month. That is financially burdensome and coming to the clinic is burdensome. But some deliveries will last a year or more.”