Age-Related Macular Degeneration (AMD): Dry, Wet and Treatment

Age-related macular degeneration, usually shortened to AMD, is a condition that damages the macula, the small central area of the retina responsible for sharp, detailed and colour vision. The macula is what you use to read, drive, recognise faces and see fine detail. When it is damaged, the centre of your vision can become blurred, distorted or develop a dark patch, while side vision usually stays intact. AMD is a leading cause of severe sight loss in older adults in high-income countries.

AMD does not cause total blindness, because peripheral vision is preserved, but advanced disease can make everyday tasks very difficult. Over the past two decades treatment has changed dramatically: injections for wet AMD now save sight for many people who would previously have lost it, and new options for advanced dry AMD are emerging. This guide explains the forms of AMD, how it is detected, which treatments and supplements have good evidence and how to check your own vision at home.

What is the macula and what goes wrong?

The retina is the light-sensitive layer at the back of the eye, and the macula is its centre, packed with cone photoreceptors. Beneath the photoreceptors is a layer of support cells called the retinal pigment epithelium (RPE), which nourishes them and removes waste. Below that is Bruch's membrane and the choroid, a rich network of blood vessels.

With age and certain genetic and environmental factors, waste products accumulate under the RPE, the support cells become stressed and parts of the system begin to fail. In some people, abnormal new blood vessels grow from the choroid into the retina. These processes define the two main forms of AMD. Our guide to eye anatomy shows how these layers fit together.

Stages and types of AMD

Early and intermediate AMD

The earliest sign is drusen: small yellowish deposits of fatty and protein material that collect under the retina. Small drusen are common with age and not necessarily a concern. Medium and large drusen, together with pigment changes, indicate early or intermediate AMD. Most people have no symptoms at these stages, though some notice they need more light for reading or that their eyes adapt more slowly to dim rooms.

Dry AMD and geographic atrophy

Dry (non-neovascular) AMD accounts for the majority of cases. It tends to progress slowly over years. In its advanced form, called geographic atrophy, patches of RPE and photoreceptors die, leaving well-defined areas of lost function. These patches gradually enlarge and, when they reach the very centre, cause a blind spot in central vision.

Wet AMD

Wet (neovascular) AMD occurs when abnormal, fragile blood vessels grow beneath or into the retina. They leak fluid and blood, causing swelling and, if untreated, scarring. Wet AMD is less common but responsible for a large share of severe vision loss from AMD, because it can damage central vision within weeks or months. Dry AMD can turn into wet AMD at any stage, which is why monitoring matters.

Symptoms to watch for

• Blurred central vision, making reading and faces harder to see.
• Distortion (metamorphopsia): straight lines, such as door frames or tiles, look wavy or bent.
• A dark, grey or empty patch in the centre of vision.
• Faded colours and reduced contrast.
• Difficulty adapting from bright light to dim light.
• Visual hallucinations (Charles Bonnet syndrome): some people with significant sight loss see simple patterns or detailed images that are not there. This is a response of the brain to missing input, not a sign of mental illness.

Because AMD often affects one eye first, the better eye may mask early problems. Covering each eye in turn is the best way to notice changes.

Risk factors

• Age: the main risk factor, increasing sharply after 60.
• Smoking: roughly doubles to triples the risk and is the most important modifiable factor. See smoking and eye disease.
• Genetics and family history: variants in genes such as CFH and ARMS2 are strongly linked to AMD.
• Ethnicity: advanced AMD is more common in people of European descent.
• Cardiovascular risk factors: high blood pressure, high cholesterol and obesity are associated with higher risk.
• Diet: low intake of leafy green vegetables, fish and fruit has been linked with higher risk in observational studies.

How AMD is diagnosed

An eye care professional will check your visual acuity, examine the retina through dilated pupils and usually perform optical coherence tomography (OCT), a fast, non-invasive scan that shows the retinal layers in cross-section. OCT is excellent at detecting fluid from wet AMD and at monitoring response to treatment. Fundus photographs and autofluorescence imaging help track geographic atrophy. If wet AMD is suspected, fluorescein or OCT angiography may be used to visualise abnormal vessels. Find out more in our guide to eye examinations.

Treatment options

Wet AMD: anti-VEGF injections

Abnormal vessel growth in wet AMD is driven largely by a signalling protein called vascular endothelial growth factor (VEGF). Anti-VEGF medicines block this protein, which stops leakage and causes the abnormal vessels to regress. They are given as injections into the eye (intravitreal injections) in a clinic.

• The procedure: the eye is numbed with drops and cleaned with antiseptic, then a very fine needle delivers the medicine. It takes only a few minutes; most people feel pressure rather than pain.
• Schedule: treatment usually starts with injections at roughly monthly intervals, then the gap is adjusted to the eye's response. Many people need ongoing injections for years.
• Results: in major clinical trials, most treated patients kept their vision stable, and a significant proportion gained some vision. Results are best when treatment starts quickly, before scarring occurs.
• Risks: temporary redness, floaters or grittiness are common. Serious complications such as infection inside the eye (endophthalmitis), raised pressure or retinal detachment are rare.

Several anti-VEGF drugs exist, including longer-acting options that may allow longer intervals between injections. Your retinal specialist chooses the medicine and schedule. Photodynamic therapy and thermal laser are now used only in specific situations.

Dry AMD and geographic atrophy: treatment and support

For early dry AMD there is no specific treatment beyond monitoring, not smoking and a healthy lifestyle. For geographic atrophy, injectable medicines that target the complement system have been approved in some countries, including the United States. They can slow the growth of atrophic patches but do not restore lost vision, require regular injections and may slightly increase the risk of developing wet AMD. Availability and recommendations vary by country, and your specialist can discuss whether they are appropriate.

Low-vision rehabilitation is valuable for anyone with significant central vision loss: magnifiers, strong task lighting, high-contrast settings, large-print and talking devices, and training in using the healthier parts of the retina (eccentric viewing). Our low vision guide covers practical aids.

AREDS2 supplements: who benefits?

The Age-Related Eye Disease Studies (AREDS and AREDS2), run by the US National Eye Institute, found that a specific high-dose combination of vitamins and minerals reduced the risk of progressing to advanced AMD by about 25 percent over five years in people who already had intermediate AMD or advanced AMD in one eye. The AREDS2 formula contains vitamin C, vitamin E, zinc, copper, lutein and zeaxanthin. Lutein and zeaxanthin replaced beta-carotene, which was linked to a higher risk of lung cancer in smokers and former smokers.

Monitoring at home with the Amsler grid

An Amsler grid is a simple square grid of lines with a central dot. Looking at it with one eye at a time can reveal new distortion, wavy lines or missing areas, which may be early signs of wet AMD. You can try our free online Amsler grid test or use a printed version.

1. Wear your usual reading glasses and use good, even light.
2. Hold the grid at normal reading distance, about 30 to 40 cm.
3. Cover one eye and focus on the central dot.
4. Note whether any lines look wavy, blurred, broken or missing.
5. Repeat with the other eye. Check regularly, for example once a week or as advised.

The grid is a screening aid, not a diagnosis. Any new change should be reported promptly, even if your next appointment is soon.

Reducing your risk and protecting your vision

• Stop smoking: the benefit begins at any age.
• Eat well: plenty of leafy greens rich in lutein and zeaxanthin, colourful fruit and vegetables, and oily fish. See nutrition for eye health.
• Manage blood pressure, cholesterol and weight and stay physically active.
• Wear sunglasses with UV protection outdoors; the link with AMD is uncertain, but UV protection is good for eye health overall.
• Have regular eye exams, especially if a parent or sibling has AMD.

Eye exercises cannot slow or reverse AMD. They may help general comfort, but they should never delay professional assessment or treatment.

When to see a doctor

Book a routine eye exam if you are over 60, have a family history of AMD, or notice gradually blurred central vision or need more light to read. People already diagnosed with dry AMD should keep regular follow-up and know how to reach their eye clinic quickly.