Exudative macular degeneration is a progressive eye disease that affects the macula or central part of the retina. It causes the eye to develop leaky blood vessels behind the macula, the part of the eye that enables us to see what is straight in front of us.
The dry form of age-related macular degeneration (AMD) sometimes progresses to the more aggressive exudative or wet form.
Exudative macular degeneration can lead to rapid changes in the eye and loss of central vision.
When a person cannot see well, it impacts their quality of life and may prevent them from participating in activities they enjoy.
For this reason, people with AMD must have regular comprehensive vision exams to maintain the best possible eye health.
This article explores exudative macular degeneration, its symptoms, causes, diagnosis, and treatment.
Exudative macular degeneration is the wet form of AMD, a leading cause of vision loss in people
If a person has AMD, yellow waste protein deposits called drusen build up under the retina, causing deterioration of the macula, the central part of the retina.
AMD also causes the death of pigment epithelial cells (RPE) and photoreceptor cells.
In exudative macular degeneration, abnormal blood vessels grow behind the macula. The new blood vessels are fragile and can leak fluid and blood, resulting in scarring of the macula and can lead to rapid and severe damage.
People may find that their central vision becomes distorted or lost very suddenly, sometimes within days or weeks.
Exudative macular degeneration is an advanced and severe form of AMD that leads to rapid worsening of symptoms and vision loss.
Exudative macular degeneration is less common than dry AMD, accounting for around 10% of AMD cases but resulting in 90% of cases of legal blindness.
Doctors can use treatments to inhibit blood vessel growth in wet AMD and
Learn more about which supplements may help macular degeneration here.
People usually have dry AMD before the condition progresses to exudative macular degeneration.
The symptoms of dry AMD are typically subtle and include a blurry spot in the center of the visual field that may worsen and become more prominent and darker. This can lead to a complete loss of central vision.
According to the Bright Focus Foundation, people with exudative macular degeneration may have early-stage dry AMD for years before the condition progresses.
However, when a person has exudative macular degeneration, their straight-ahead vision may become distorted or lost in just days or weeks.
The visual symptoms of wet AMD can appear suddenly as blood vessels leak into the retina. Symptoms are usually painless and include:
- visual distortion, such as seeing straight lines as wavy
- a blind spot that seems gray, red, or black in the central visual field
- words that disappear while reading
- difficulty seeing colors
- finding bright light uncomfortable
Doctors are not sure what causes exudative macular degeneration but have linked AMD to several factors, including:
- Age. People over 55 are
more likely to develop AMD. - Smoking. People who smoke are up to four times more likely to develop AMD than nonsmokers.
- High blood pressure. If the blood vessels that supply the retina become narrowed due to high blood pressure, it increases the risk of AMD.
- Family history. Having immediate family with AMD increases a person’s risk.
- Race. Older white people are
more likely to develop AMD than people of other races. - Gender.
Females are more likely to develop AMD than males. - Diet. Consuming high amounts of fat, cholesterol, foods high on the glycemic index, and low amounts of green leafy vegetables increase a person’s risk of AMD.
Doctors are not sure why dry AMD progresses to the wet form in some people. Potentially, when photoreceptor and RPE cells die, this triggers an abnormal growth of blood vessels, and wet AMD develops.
People with dry AMD require regular comprehensive eye exams with an ophthalmologist to review their visual health.
If someone notices worsening symptoms or sudden change in the vision, they should see their eye doctor for a thorough examination, including:
- Autofluorescence. Autofluorescence photos allow the doctor to examine the retina and determine if a person’s dry AMD is progressing.
- Dilated eye exam. Using medicated eye drops to dilate the pupils, the doctor can check the retina, see if the optic nerve is damaged, and look for signs of drusen.
- Fundoscopy or ophthalmoscopy. The ophthalmologist uses a lens and shines a bright light into the eye to check the health of the retina, blood vessels, and other vital tissues behind the eye by directing looking at them.
- Optical coherence tomography (OCT). This is a noninvasive imaging test that allows the doctor to see cross-sections of the retina. They can check for thinning, swelling, and drusen and can also assess treatment responses.
Doctors use several treatment approaches to slow or prevent vision loss, although there are no cures for AMD.
Angiogenesis inhibitors
These medications block the activity of a protein that promotes blood vessel growth called vascular endothelial growth factor (VEGF).
Doctors first numb the eye then inject the inhibitor medication into the jelly-like center of the eye called the vitreous. They repeat these injections every few weeks or months depending on the drug, person’s disease status, and response to the treatment.
Rare side effects of treatment include blurred vision, swelling, discharge, pain, and discomfort. They may also cause cataracts and bleeding in the eyes.
The Food and Drug Administration (FDA) has approved the following angiogenesis inhibitors:
- brolucizumab (Beovu)
- aflibercept (Eylea)
- ranibizumab (Lucentis)
- pegaptanib sodium (Macugen)
The FDA also approved bevacizumab (Avastin) to inhibit blood vessel growth in colorectal and some other cancers. Doctors may opt to use this drug off-label to treat wet AMD. Off-label means using medication for purposes other than the approved ones.
Doctors may opt to use Avastin because it is much less expensive than the other anti-VEGF medications.
Learn how to save money on prescription drugs here.
Photodynamic therapy
If a person has a subtype of wet AMD called predominantly classic subfoveal AMD, photodynamic therapy (PDT) is an
During the procedure, doctors inject a drug called Visudyne into the person’s arm, which travels through the body before reaching the leaking blood vessels in the eye.
Doctors use a low-intensity laser directed at the retina for around one minute to activate the Visudyne, causing it to destroy abnormal blood vessels.
Side effects are minimal and include headaches, a reaction at the injection site, and blurred vision.
Learn about different types of injections here.
Laser surgery
Laser surgery is an option for a small number of patients. During the procedure, a doctor numbs the eye and uses a laser to seal and destroy the leaky blood vessels in the eye.
The surgery can potentially prevent further loss of vision. However, the scarring causes a permanent blind spot.
New treatments involving gene therapy may also be on the horizon for wet AMD.
If a person does not seek treatment for exudative macular degeneration, it can cause a rapid loss of central vision.
Although this form of macular degeneration accounts for just 10% of cases, it contributes to around 90% of significant vision losses from AMD.
If a person is living with vision loss, vision rehabilitation can help them learn coping strategies.
For example, a low vision specialist such as an optometrist can help individuals modify their environment and optimize the use of their peripheral vision.
Additionally, support groups can help people cope with their vision loss by providing resources and a space to share experiences.
Learn more about different types of eye doctors here.
Exudative macular degeneration or wet form age-related macular degeneration (AMD) is an advanced form of the condition. Around 10% of AMD cases progress to the wet form.
In exudative macular degeneration, faulty blood vessels develop behind the macula and exude or leak blood, causing scarring and loss of central vision.
Doctors can treat wet AMD by injecting drugs into the eye, photodynamic therapy, or laser surgery. However, this does not cure the condition. Instead, it slows down or stops the loss of vision.
If a person has dry AMD and notices any worsening of their symptoms, they should seek urgent medical attention.