Wet vs Dry Macular Degeneration: What is the Difference?

Age-Related Macular Degeneration (AMD)

18 September 2024

It’s easy to get confused by the differences between wet vs dry macular degeneration. Both damage your central vision and have similar symptoms, but they progress and are treated very differently. Wet macular degeneration is usually more severe and happens quicker because scar tissue builds up when abnormal blood vessels grow under the retina. Dry age-related macular degeneration progression is slower. The subtleties between these two forms can make it difficult to know if you have one or the other and what to look out for. In this article, Optegra Eye Health experts will explain the key differences between wet and dry macular degeneration and help you understand the symptoms and know when to get help.

What is the Difference Between Wet and Dry Macular Degeneration?

Dry AMD is the early stage of macular degeneration. Vision changes can be subtle, with blurry vision reduced contrast sensitivity and mild colour vision changes.

Wet AMD is advanced AMD, and patients experience significant central vision loss, objects may appear wavy, and vision-related quality of life can be significantly impacted.

What is Dry Macular Degeneration?

The more common AMD is the dry form. In dry AMD, the part of the retina that provides our most detailed vision, known as the macula, thins and breaks down gradually over time. This results in a gradual loss of central vision, so it becomes harder to read or recognise someone’s face.

What is Wet Macular Degeneration?

Wet macular degeneration, less common than dry AMD, but more serious, is characterised by the development of abnormal blood vessels under the retina that seep blood or fluid and damage the macula. Wet AMD, which can result in central loss of vision, may be described by a patient as a dark or blurry spot in the middle of their vision or wavy lines. Treatments for wet macular degeneration need to be immediate to avoid further vision loss.

Can You Drive with Macular Degeneration?

It depends on how advanced the disease is and whether it is in one or both eyes. Most people in the early stages of dry AMD can continue driving safely. It is important to see an eye care professional regularly to discuss any vision changes and the ability to continue driving.

At What Age Can Macular Degeneration Start?

Macular degeneration is an age-related condition and most commonly occurs in people aged 60 or over. Those with poor diet, family history, and smokers are at increased risk; This is why it’s essential to get regular eye exams to detect the disease early so intervention can be planned.

How Macular Degeneration Affects the Eyes

Macular degeneration affects only the central part of the retina, called the macula, which is responsible for central, detailed vision. As the disease advances, sufferers can develop several visual changes, including a curious phenomenon known as metamorphopsia, where straight lines can appear wavy or bent. Another common symptom is the emergence of ‘holes’ or small, blurry, or dark spots in the centre of vision. This can make it difficult to see faces, read, or do other activities that require fine detail. Over time, these symptoms can worsen, leading to severe functional impairment.

How Often Does Dry Macular Degeneration Turn into Wet Macular Degeneration?

While dry macular degeneration is more common and progresses slowly, about 10-15% of individuals with dry AMD develop the more severe wet form (according to NCBI).

This can result in swift and severe vision loss caused by abnormal blood vessel growth underneath the retina. Regular eye-care visits can help catch the progression from dry to wet AMD early, when it can be most effectively slowed down and vision preserved.

Which is Considered Worse, Dry or Wet Macular Degeneration?

The wet form of macular degeneration is generally worse than the dry. Both forms of AMD can lead to severe vision loss, but wet retinal degeneration is considered worse because it progresses much more rapidly and can cause sudden, significant loss of central vision. The abnormal blood vessels grow underneath the retina and leak fluid or blood, causing rapid damage to the macula. The dry form of AMD progresses more slowly and is less likely to cause sudden vision loss, but it can still cause profound vision problems over time. Early detection and treatment, particularly for wet AMD, can often prevent or limit vision loss.

How Do Treatment Options Differ Between Wet and Dry Macular Degeneration?

There is a huge difference in how wet and dry MDs are treated because they are fundamentally different diseases.

The only way of managing this condition is with wet MD through continuous, specialised treatment to halt the disease’s rapid progression and to prevent profound vision loss, especially in the eye where symptoms first appear. The mainstay of treatment involves monthly anti-VEGF (vascular endothelial growth factor) injections into the eye to block the proliferation of new blood vessels and prevent leakage, stabilising or even improving vision. Laser therapy, while less frequently used, can be used to destroy abnormal blood vessels.

With dry MD, progression can often be slowed with lifestyle changes and prevention strategies, such as eating a diet rich in leafy greens and antioxidants and eating foods that can reduce your risk of heart disease, like omega-3 fatty acids. Giving up smoking and managing conditions such as high blood pressure can also help. For those with moderate to severe dry AMD, supplements containing specific vitamins and minerals, like the AREDS2 formula, can also reduce the risk of progression.

The Role of Lifestyle Changes in Dry MD vs. Continuous Treatment for Wet MD

Dry MD management generally involves lifestyle changes and prevention, while wet MD usually requires persistent medical treatment to control the disease and protect vision.

Those with dry MD have a major role to play in managing the disease; lifestyle changes can be enormously beneficial. ‘a healthy diet, regular exercise, and not smoking are key factors in reducing the risk of progression from early to advanced stages of dry AMD.’ says Emily Chew, director of the NEI’s Division of Epidemiology and Clinical Applications.

By contrast, wet MD generally demands ongoing, specialised medical care that involves frequent injections of anti-VEGF drugs. ‘patients with wet AMD need to be closely monitored and treated regularly with anti-VEGF injections to maintain their vision and prevent further deterioration.’ says Paul Sternberg, MD, professor and chair of the Department of Ophthalmology and Visual Sciences at Vanderbilt University in Nashville, Tennessee. This need for frequent treatment is because wet MD is an aggressive disease that will cause vision to be quickly lost if it isn’t treated quickly.

How to Spot the Early Signs of Macular Degeneration

The sooner the signs of macular degeneration are spotted, the better the chance of preventing serious loss of vision. The earlier a patient can go to an eye doctor; the sooner treatment can begin, and the better the chance of slowing the disease and preserving eyesight for as long as possible. For dry macular degeneration, early signs and symptoms, along with lifestyle changes – such as eating well, stopping smoking, and taking care of general health – can delay the progress of the disease.

Catching it early is even more critical for wet macular degeneration. That’s because this type of disease can lead to quick and severe vision loss. If treatment starts as soon as symptoms show up, then the macula will be preserved and not damaged any further. So, regular eye examinations are essential, especially for people over age 50 or with a family history of the disease, because the sooner macular degeneration is detected, the more effective treatment and prevention can be. Again, this will help maintain quality of life and independence.