Angeles Vision Clinic
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For reasons that are not fully understood, a minority of people with macular degeneration develop a more serious form of the disease. People with large "soft" drusen (drusen with indistinct borders) or many drusen that run together are at greater risk for developing the wet (exudative) form of the disease.
In wet macular degeneration, new blood vessels grow underneath the retina in a process called choroidal neovascularization, or CNV.
In the wet form of macular degeneration, new blood vessels begin to grow underneath the retina. The proliferation of these new blood vessels is called choroidal neovascularization, or CNV.
It is believed that the diseased retina stimulates the production of these new blood vessels in response to a decreased supply of nutrients and slow transport of wastes. Unfortunately, new blood vessels do not improve the health of the retina. Instead, they often leak blood or fluid into the retina.
This retinal photograph shows fluid and blood beneath the retina which suggests the presence of choroidal neovascularization (CNV).
As CNV continues, the new vessels may leak blood or fluid under the retina, causing the retinal surface to become uneven. As a result, objects in that portion of your visual field may appear wavy or distorted (See: Amsler Grid). The neovascularization may even break through some of the retinal layers. Blind spots may appear in your vision if portions of the retina become damaged by the CNV.
As the surface of the retina becomes uneven, objects in your vision may appear blurred, wavy ,or distorted. As the condition progresses, blind spots may appear.
Often the first sign of fluid under the retina is distortion of straight lines. Just as in a camera, if the film is not lying flat, images will be distorted. Since these changes can be subtle, regular testing with the Amsler grid can be helpful in detecting problems early.
The first indication of fluid under the retina may be a distortion of straight lines.
The Amsler grid test is an important tool for the early detection of any changes in your vision. Any change in the appearance of the grid may be a sign of choroidal neovascularization and should prompt a visit to the eye doctor. If caught early enough, the CNV might be treatable with a laser or a new procedure called Photodynamic therapy using Visudyne .
Eventually, areas of neovascularization and leakage can lead to the death of the overlying photoreceptors and scarring of the macula. Scarring is the final stage of macular degeneration, and it frequently results in significant visual loss.
This retinal photograph shows a large yellow scar in the macular region resulting from advanced CNV.
A person with this type of scarring would experience a significant loss of vision in that eye. It is important to realize that this entire process occurs only in the macula, and affects only central, or detail vision. Peripheral, or side vision is rarely affected by macular degeneration. While macular degeneration is the leading cause of legal blindness, it does not usually lead to total blindness.