Macular Degeneration

Types of Wet AMD

It is important for you to understand what your doctors are talking about when they describe your case of wet macular degeneration. The following definitions are provided to help you understand.

The neovascular "wet" form of macular degeneration is characterized by the invasion of new, poorly formed blood vessels beneath the retina (from the choroid). Since these new blood vessels are poorly formed, they leak their contents into the retina and subretinal space. The contents of blood vessels include red blood cells, white blood cells, serum, and fats. These contents can cause injury to the retina and promote scarring of the fovea (central macula). Scarring results in loss of vision.

Classification of Choroidal Neovascular Vessels By Location:

Subfoveal: Under the center of the fovea. This location is particularly important because when subfoveal blood vessels are treated with laser photocoagulation, patients are likely to notice an immediate loss of some central vision.

Juxtafoveal: within 2OO microns of the foveal avascular zone but not under it. When juxtafoveal blood vessels are lasered, you will likely notice a dark spot in your vision, but you may keep your ability to read.

Extrafoveal: More than 200 microns from the foveal avascular zone. These blood vessels have the best chance of being successfully treated with laser photocoagulation without a noticeable change in vision (as long as they aren't too large).

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Classification of Macular Degeneration (CNV) Neovascularization by Pattern of leakage on Flourescein Angiography:

Classic: A well demarcated area of hyperfluorescence in the early frames of the fluorescein angiogram with increased fluorescence caused by pooling of the dye in the late phases of the study.

Occult: Early frames show poorly demarcated areas of hyperfluorescence, with persistent and increased staining in the late phases of the study. More often associated with subretinal blood, fluid, and exudates.

Mixed: A mixture of classic and occult neovascular patterns on the fluorescein angiogram.

Recurrent: Classic, occult or mixed type neovascular patterns on the fluorescein angiogram with a previous history of leakage or treatment (most commonly laser photocoagulation).

*Note* Without treatment (after 5 years), most patients with occult, classic, mixed, and recurrent type wet macular degeneration will end up with poor vision. In general, patients with a "classic" component lose vision more quickly.

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