Wet Age Related Macular Degeneration

Wet AMD occurs when abnormal blood vessels grow under the retina and leak causing vision loss.

What is wet macular degeneration?

Wet macular degeneration occurs when abnormal blood vessels (known as choroidal neovascularization) grow under the macula. These new blood vessels may then bleed and leak fluid, causing the macula to bulge or lift up from its normally flat position, thus distorting or destroying central vision. It is called wet because of the fluid the leaks from the abnormal blood vessels. Patient with wet macular degeneration usually develop rapid vision loss over the course of weeks or months. Straight lines may look wavy because the macula is no longer smooth. Below is a discussion of various manifestations of wet AMD. Click the button to learn more about the treament of wet AMD

Treatment of Wet AMD

What is a Choroidal Neovascular membrane?

Choroidal neovascular membranes are new blood vessels that grow beneath the retina and disrupt vision. These blood vessels grow in an area called the choroid, the area between the retina and the sclera (the white part of your eye). The choroid supplies oxygen and nutrients to the eye. These blood vessel growths break through the barrier between the choroid and the retina. Although one would think that more blood vessels supplying nutrients to the eye would be good, it is not. The new blood vessels grow out with scarring. Also, they leak more than normal retinal blood vessels. Finally they can bleed and blood is very harmful to the retina. Rarely patient maintain good vision with choroidal neovascular membranes (about 10 or 20 percent). Most people lose central vision rapidly who develop choroidal neovascular membranes unless they are treated.

What is a Disciform Scar?

Untreated, a person with a choroidal neovascular membrane will usually develop a submacular scar like the one in the photo. The scars are white because the are composed mostly of fibroblasts. Subretinal scars cause degeneration of the overlying retina and loss of vision. The scars are circular or disc shaped and therefore are called disciform scars. They cause vision loss because they block the transport of nutrients from the supporting tissue under the retina (the retinal pigment epithelium) which is vital to the survival and function of the retina. Unfortunately, once the retina has been permanently damaged by a submacular scar it cannot be resurrected. Retinal tissue does not regenerate. It cannot be replaced. Research is being pursued all over the world trying to find a way to fix damaged retinas, but nothing, at the moment (January 2015) is close to being effective.

What is Subretinal Fluid?

A hallmark of wet AMD is subretinal fluid. This comes from leaking abnormal blood vessels under the macula. Their is not a firm attachment between the retina and the underlying retinal pigment epithelium. The retina is held in place against the underlying retinal pigment epithelium by a pump in the retinal pigment epithelium. This pump removes naturally occurring fluid in the subretinal space and keeps it dry. The leakage from a choroidal neovascular membrane overwhelms the natural pump in the retinal pigment epithelium and subretinal fluid accumulates. The subretinal fluid distorts the retina causing patients to see things as wavy instead of straight. It also decreases the supply of oxygen and nutrients to the retina and makes the vision blurry. Subretinal fluid is best dectected using optical coherence tomography. The photo shows a dark area under the retina where subretinal fluid has accumulated. The effect (or lack of effect) of treatments for wet macular degeneration is usually evaluated by monitoring the optical coherence tomography scan for subretinal fluid.

What is a Pigment Epithelial Detachment?

Most patients with wet AMD develop a retinal pigment epithelial detachment. The retinal pigment epithelium is a layer of cells under the retina that supports the retina. In the OCT image it is the bright white line closest to the bottom of the picture with RPE on top of it. (there are two lines, the line on the bottom is the RPE, the line on the top is the back of the retina). When fluid or lipid (fatty material) or blood vessels accumulates under the retinal pigment epithelium the retinal pigment epithelium is pushed up. The bump in the retinal pigment epithelium is called a pigment epithelial detachment. These are common in wet AMD. Treatment does not always cause the retinal pigment epithelial detachment to flatten. Vision can be excellent over a retinal pigment epithelial detachment. The distortion of the overlying retina will often cause distortion in the vision. Retinal pigment epithlial detachments do not compromise the ability of the retinal pigment epithelium to nurish the retina. Finally, you can develop a retinal pigment epithelial detachment without wet AMD. These retinal pigment epithelial detachments have lipid (fatty) material in them but no blood vessels. About 90 percent of retinal pigment epithelial detachments are associated with wet AMD and abnormal blood vessel growth.

What is a Polypoidal Choroidal Vasculopathy (PCV)?

Polypoidal choroidal vasculopathy is a subtype of wet AMD that is caused by a mature vascular complex under the retina. It is characterized by a branching vascular network with one or more polyps at the termini of the vessels. The branching vascular network and the polyp(s) are best seen with indocyanine green angiography. There is some evidence the polypoidal choroidal vasculaopathy (PCV) is less response to anti-VEGF injection therapy than other forms of wet AMD. In many cases photodynamic therapy is helpful in treating PCV.

What is a Submacular Hemorrhage (Blood)?

Submacular hemorrhage (blood) is one of the most feared complications of wet AMD. The blood is toxic to the overlying retina and causes immediate severe vision loss. The photo shows blood in a patient whose vision dropped from 20/30 immediately to 20/1600 (no longer able to see even the big letters on the visual acuity chart). Fortunately, submacular hemorrhage is rare and occurs in only about 1 percent of patient with wet AMD. Once there is a submacular hemorrhage, vision almost never returns to what it was before the bleed. Treatment of wet AMD helps reduce the amount of vision loss. Surgery for submacular hemorrhage is controversial and may not be helpful. Visual recovery in someone with a submacular hemorrhage is very very slow. It usually takes about 6 months for the blood to absorb and then another 6-12 months for the overlying retina to heal. Vision usually improves some as the blood absorbs but not much. Most patients recover enough vision to see the big letters on the visual acuity chart but not enough vision to read.

Wet Macular Degeneration NEWS

Below are current articles from a Google News Feed on Wet Macular Degeneration

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Nasdaq

FDA Approves Aflibercept sBLA for Wet Age-related Macular Degeneration
MD Magazine
The sBLA was based on results from a second year of the phase 3 VIEW 1 and 2 trials of patients with wet AMD. Participants were treated with a modified 12-week dosing schedule, where doses were given at least every 12 weeks and more often if necessary) ...
FDA approves Eylea 12-week dosing for wet AMDHealio
FDA Approves EYLEA® (aflibercept) Injection sBLA in Wet Age ...Markets Insider
FDA Approves EYLEA® (aflibercept) Injection sBLA in Wet Age-related Macular DegenerationPR Newswire (press release)
Nasdaq -Reuters -The Pharma Letter -Regeneron Pharmaceuticals
all 22 news articles »

Business Wire (press release)

Dry Age-Related Macular Degeneration | A Drug Pipeline Analysis ...
Business Wire (press release)
Technavio has published a new report on the drug development pipeline for dry age-related macular degeneration, including a study of the molecules.
Dry Age-Related Macular Degeneration | A Drug Pipeline Analysis Report 2018 | TechnavioTullahoma News and Guardian
Global Age-related macular degeneration Market - Global Forecast Till 2023MENAFN.COM

all 15 news articles »

Regeneron Pharma: FDA Okays EYLEA Injection SBLA In Wet AMD
Markets Insider
(RTTNews) - Regeneron Pharmaceuticals, Inc. (REGN) said that the U.S. Food and Drug Administration or FDA has approved a supplemental Biologics License Application or sBLA for Eylea (aflibercept) Injection in patients with wet age-related macular ...


FDA OKs 12-week dosing regimen for Regeneron's Eylea in wet AMD
Seeking Alpha
In an about-face, the FDA approves a 12-week dosing schedule (after the initial lead-in phase) for Regeneron Pharmaceuticals' (NASDAQ:REGN) EYLEA (aflibercept) in patients with wet age-related macular degeneration (wet AMD), adding to the four- and ...


Forbes

RegenXBio Gene Therapy Shows Early Promise For Eye Disease; Cholesterol Treatment Results Mixed
Forbes
A gene therapy being developed by RegenXBio of Rockville, MD, showed early promise against wet macular degeneration, a leading cause of blindness. Another RegenXBio gene therapy, for a genetic disease that causes high cholesterol levels, showed ...
REGENXBIO Reports Second Quarter 2018 Financial and Operating Results and Interim Data from Ongoing Clinical ...PR Newswire (press release)
REGENXBIO to Host Conference Call and Webcast on August 8 to Discuss Second Quarter 2018 Financial and ...Markets Insider
REGENXBIO INC. (NASDAQ:RGNX) Files An 8-K Results of Operations and Financial ConditionMarket Exclusive
PR Newswire -Seeking Alpha -Motley Fool -StreetInsider.com
all 58 news articles »

Nasdaq

Regeneron's 12-Week Eylea Dose Gets CRL From FDA for Wet AMD
Nasdaq
The sBLA sought to expand Eylea's label to patients with wet age-related macular degeneration (wet AMD). The sBLA was based on the second-year data from the VIEW studies, during which patients were treated with a modified 12-week dosing schedule ...
FDA issues complete response letter on Eylea 12-week dosingHealio
Regeneron Receives Complete Response Letter for Eylea InjectionR & D Magazine

all 5 news articles »

MD Magazine

Genentech Unveils Positive Phase II Results for the First-Ever Eye Implant to Achieve Sustained Delivery of a ...
BioSpace (press release) (blog)
“If the PDS is successful, it could have a major impact on the way we treat people with wet AMD,” said Carl D. Regillo, M.D., FACS, Chief of Retina Service at Wills Eye Hospital in Philadelphia, PA and investigator for the LADDER study. “I believe that ...
Positive phase 2 results reported for implantable wet AMD treatmentHealio
Port Delivery System Proves Effective for Patients with Wet AMD in LADDER TrialMD Magazine
Roche's eye implant for wet AMD shows positive effect in mid-stage study; shares up 2%Seeking Alpha
Mass Device
all 5 news articles »

StreetInsider.com

Regeneron's Eylea Stumbles as FDA Issues CRL for New Dosing Label
BioSpace (press release) (blog)
The U.S. Food and Drug Administration (FDA) rejected the company's attempt to secure a supplemental approval for its blockbuster drug Eylea as a once-per 12-week treatment for wet age-related macular degeneration (wet AMD). This morning, Regeneron ...
Regeneron (REGN) Announces Regulatory Update on EYLEA (aflibercept) Injection sBLA in Wet Age-Related Macular ...StreetInsider.com
Regeneron's hope for a longer-lasting Eylea delayedBioPharma Dive
FDA Issues Complete Response Letter For Regeneron's SBLA For EYLEA - Quick FactsNasdaq

all 15 news articles »

Seeking Alpha

Allergan's Big Win For 12-Week Wet AMD Dosing With Abicipar May Be Enough To Pit It Against A Host Of Competitors
Seeking Alpha
Allergan and Molecular Partners achieve positive results in two phase 3 studies using abicipar for treating patients with wet age-related macular degeneration. The primary endpoints for both phase 3 studies were reached, but the full set of results won ...
Allergan's abicipar matches AMD blockbuster Lucentis in phase IIIPMLiVE

all 8 news articles »

Nasdaq

ETF Preview: ETFs, Futures Point Lower Amid Turkey Jitters and Weak Semiconductor Outlook
Nasdaq
Regeneron Pharmaceuticals (REGN) said the US Food and Drug Administration (FDA) has approved a supplemental Biologics License Application (sBLA) for EYLEA Injection in patients with wet age-related macular degeneration (wet AMD). The views and ...

and more »

What is Macular Degeneration?
Williston Daily Herald
Macular degeneration, ever heard of it? Macular degeneration is the leading cause of vision loss among older Americans and should be taken as seriously as it sounds. MD occurs when the central portion of your retina, called the macula, is damaged and ...


Fewer doses of abicipar yield similar efficacy as ranibizumab for wet AMD
Healio
The anti-VEGF abicipar pegol was similarly efficacious in treating neovascular age-related macular degeneration as ranibizumab, meeting the primary endpoint of non-inferiority in two phase 3 clinical trials, Allergan and Molecular Partners announced in ...

and more »

BBC News


Seeking Alpha

Regeneron's Pain Is Novartis' Gain - Novartis AG (NYSE:NVS ...
Seeking Alpha
Novartis gains advantage as Regeneron runs into labeling issue for the sBLA of its 12-week injection dosing for EYLEA. The exact labeling issue is not yet ...

and more »

Treat-and-extend with ranibizumab comparable to monthly treatment for wet AMD
Healio
VANCOUVER, British Columbia — A 24-month treat-and-extend analysis trial with ranibizumab for patients with neovascular age-related macular degeneration showed statistically significant improvements in best corrected visual acuity at 12 months ...


Daily Mail

Viagra could be a new miracle cure for BLINDNESS, scientists claim
Daily Mail
The rest involve wet AMD, which can cause blindness in as little as three months. Dry AMD usually develops after the age of 50 and is caused by the growth of new blood vessels over the macula, a small oval-shaped area at the back of the eye that helps ...

and more »

MD Magazine

Long-Term Effects of Anti-VEGF Therapy Sustained with Radiation
MD Magazine
“Intravitreal anti-VEGF therapy is an effective therapy to control vision loss associated with wet macular degeneration. However, the treatment effect does not last and needs to be repeated frequently in a majority of eyes. By combining the treatment ...


MD Magazine

Investigative Gene Therapy RGX-314 Reduces Anti-VEGF Dosing in AMD Patients
MD Magazine
According to the interim data update, 18 patients with wet AMD were administered 1 dose of RGX-314 across 3 dose cohorts. Patients included in the trial had a history of frequent anti-VEGF treatment (as defined by at least 4 injections in the 8 months ...
Regenxbio dips as gene therapy platform yields mixed resultsBioPharma Dive

all 5 news articles »

MedPage Today

Device Extends Treatment Interval for AMD
MedPage Today
"If the port system is validated in phase III, it could significantly reduce the treatment burden on patients with wet macular degeneration, with regard to the visits and injections that we do," Eichenbaum told MedPage Today. "It is burdensome for this ...
Genentech's eye implant shows significant effect in phase II LADDER studyCompelo

all 3 news articles »

The Sun

Scientists claim Viagra could new miracle cure for BLINDNESS
The Sun
Tests by researchers at Colombia University in New York suggest the anti-impotence drug could halt age-related macular degeneration, or AMD. About 600,000 Brits are understood to have suffered loss of sight as a result of the condition, making it the ...
Viagra Could Be A Miracle Cure For Blindness, According To ResearchLADbible

all 3 news articles »

The Pharma Letter

Roche presents promising results for new wet AMD product
The Pharma Letter
Roche (ROG: SIX) group member Genentech has revealed positive top-line results from the Phase II LADDER study of its investigational Port Delivery System with ranibizumab (PDS) in people with wet age-related macular degeneration (AMD). The PDS ...


MD Magazine

Insomnia Linked to Increased Risk of Developing AMD
MD Magazine
The results showed that, in total, 1.9% (n = 2094) of the sampled subjects were diagnosed with AMD, including 0.2% (n = 214) with wet AMD, over the mean follow-up period of 5.1 ±2.8 years. After adjusting for age, sex, baseline comorbidities, and the ...


Choroidal Neovascularization | A Drug Pipeline Analysis Report 2018 | Technavio
Maryville Daily Times
It is a common cause of neovascular degenerative maculopathy, which is also known as wet macular degeneration. Extreme myopia, malignant myopic degeneration, or age-related developments commonly exacerbate choroidal neovascularization.

and more »

Medical Xpress

Saving the sight of millions
Medical Xpress
Worldwide, over 12 million intravitreal injections are delivered for sight-threatening conditions such as age-related macular degeneration, retinal vein occlusions and diabetic retinopathy. Fundamentals of Intravitreal ... Intravitreal injections ...

and more »

MD Magazine

ASRS Preferences and Trends Survey Documents State of AMD, Retina Care
MD Magazine
A respective 72.7% of US and 79.4% of international specialists said aflibercept most effectively treats the broadest range of patients with wet-AMD. Another 20.5% of US specialists and 14.9% of international specialists said there is “no difference ...


Nasdaq

MBIO & Bubble Boy Disease Gene Therapy, Busy Months Ahead For EIGR, UMRX
Nasdaq
MBIO closed Monday's trading at $6.27, down 2.18%. Regeneron Pharmaceuticals Inc.'s (REGN) supplemental Biologics License Application for EYLEA with a modified 12 week dosing schedule in patients with wet age-related macular degeneration has ...

and more »

Medscape

New Geographic Atrophy Treatment Shows Promise
Medscape
Vascular endothelial growth-factor (VEGF) inhibitors have greatly improved the outlook for patients with neovascular, or wet, age-related macular degeneration, but treatments for geographic atrophy, or late-stage dry age-related macular degeneration ...


Adverum Biotechnologies reports quarterly net loss
Healio
In July, Adverum submitted an investigational new drug application to the FDA for ADVM-022, a potential treatment for wet age-related macular degeneration. ADVM-022 has been shown to be safe and statistically significant in preventing the development ...

and more »

Wet Macular Degeneration Market 2027 Forecast, Factors driving growth with Risk & Burden
Tech Journal Hub (blog)
Wet Macular Degeneration Market 2027 report provides a Complete analysis of the Wet Macular Degeneration epidemiology, providing the historical and forecasted data for the 7MM during the forecast period from 2016-2027. The epidemiology section ...

and more »

BioSpace (press release) (blog)

FDA Action Alert: DURECT, Vertex, Alnylam, and Regeneron
BioSpace (press release) (blog)
The decision is regarding a 12-week dosing interval in wet age-related macular degeneration (AMD). Eylea is approved for wet AMD, diabetic macular edema (DME) and diabetic retinopathy (DR) in DME, and macular edema following retinal vein occlusion ...

and more »
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What about Resources?

Dr. Pautler's Blog
American Academy of Ophthalmology
MedlinePlus
National Institutes of Health
  • ARMD
    NIH's SeniorHealth website covers the topic of Age-Related Macular Degeneration
National Eye Institute
American Foundation for the Blind - Senior Site
  • Macular Degeneration
    Basic information about AMD and low vision; includes a self-test using an Amsler Grid
Journal of the American Medical Association (JAMA)
WebMD
LightHouse International
  • Macular Degeneration
    Provides a general overview of the basics of AMD, and a simulation showing a scene as it might be viewed by a person with AMD
Prevent Blindness America