Macular Degeneration (AMD): Symptoms, Treatment & Vision Care

Age-related macular degeneration (AMD) is the leading cause of vision loss in people over 50, affecting approximately 196 million people worldwide. AMD damages the macula, the central part of the retina responsible for sharp, detailed vision. While there is no cure, early detection and treatment can significantly slow progression. Wet AMD can be treated with anti-VEGF injections that stabilize or improve vision in 90% of patients. Dry AMD progresses more slowly and can be managed with lifestyle changes and specific vitamin supplements.

What Is Age-Related Macular Degeneration?

Age-related macular degeneration (AMD) is a progressive eye disease that damages the macula, the small central area of the retina responsible for sharp, straight-ahead vision. AMD is the leading cause of permanent vision loss in people over 50 in developed countries, affecting reading, driving, recognizing faces, and other activities requiring detailed vision.

The macula is a small but crucial part of the retina, measuring only about 5 millimeters in diameter. Despite its small size, the macula contains the highest concentration of photoreceptor cells called cones, which are responsible for color vision and the fine detail needed for activities like reading and recognizing faces. When the macula deteriorates due to AMD, central vision becomes blurred, distorted, or completely blocked, while peripheral (side) vision typically remains unaffected.

AMD develops when the layer of cells beneath the retina, called the retinal pigment epithelium (RPE), begins to accumulate waste products and break down. This process is influenced by aging, genetics, cardiovascular health, and environmental factors such as smoking. The disease typically affects both eyes, though often one eye is affected before the other, and progression can vary significantly between eyes.

Understanding AMD requires recognizing that it exists on a spectrum of severity. Early AMD may cause no noticeable symptoms and is often detected only during routine eye exams. Intermediate AMD begins to affect vision subtly, while advanced AMD causes significant vision impairment. The distinction between dry and wet forms of AMD is crucial because they differ in progression, symptoms, and treatment options.

Dry AMD (Non-Neovascular)

Dry AMD accounts for 85-90% of all AMD cases and is characterized by the gradual breakdown of the light-sensitive cells in the macula. The hallmark of dry AMD is the accumulation of drusen, which are yellow deposits of fatty proteins that accumulate beneath the retina. Small drusen are common in people over 50 and may not affect vision, but larger drusen are associated with an increased risk of vision loss.

In dry AMD, the photoreceptor cells and supporting RPE cells slowly deteriorate over years to decades. This gradual process means that many people with early dry AMD maintain good vision for a long time. However, as the disease progresses to advanced dry AMD, also called geographic atrophy, patches of cells die off, creating areas of complete vision loss in the central visual field.

Wet AMD (Neovascular)

Wet AMD, though less common (10-15% of cases), is responsible for approximately 90% of severe vision loss from AMD. In wet AMD, abnormal blood vessels grow from the choroid (the layer of blood vessels beneath the retina) into the space under or within the retina. This process is called choroidal neovascularization.

These new blood vessels are fragile and prone to leaking blood and fluid, which damages the macula and can cause rapid, severe vision loss within days to weeks. Unlike dry AMD, which progresses gradually, wet AMD can cause sudden, dramatic changes in vision. The good news is that wet AMD can be effectively treated with anti-VEGF medications that stop the growth of these abnormal vessels.

What Are the Symptoms of Macular Degeneration?

Early AMD often has no symptoms. As the disease progresses, common symptoms include blurred central vision, difficulty seeing in low light, straight lines appearing wavy or distorted, colors appearing less vibrant, and difficulty recognizing faces. Sudden distortion or a dark spot in central vision requires immediate medical attention as it may indicate wet AMD.

Symptoms of macular degeneration vary depending on the type and stage of the disease. Because peripheral vision remains intact, AMD never causes complete blindness. However, the loss of central vision significantly impacts daily activities that require detailed sight. Understanding the specific symptoms associated with each form of AMD helps with early detection and timely treatment.

Many people with early AMD have no noticeable symptoms at all. The disease may be present for years before causing any visual disturbance, which is why regular comprehensive eye exams are crucial for early detection. Drusen, the characteristic deposits of dry AMD, can only be seen during a dilated eye examination and are often the first sign that AMD is developing.

As AMD progresses, the symptoms become more apparent and can significantly affect quality of life. The brain initially compensates for mild vision loss, especially when only one eye is affected, which can mask early symptoms. Testing each eye individually, such as with an Amsler grid, helps detect changes that might otherwise go unnoticed.

Symptoms of Dry AMD

Dry AMD typically causes symptoms that develop gradually over months to years. Because the changes are slow, many people adapt without realizing their vision is declining. The most common symptoms of dry AMD include:

• Gradual blurring of central vision: Words may appear fuzzy when reading, and fine details become harder to see
• Need for brighter lighting: Activities like reading or sewing require more light than before
• Difficulty adapting to low light: Transitioning from bright to dim environments takes longer
• Difficulty recognizing faces: Facial features may appear unclear until very close
• Printed words appearing blurry: Letters or parts of words may seem to disappear
• Colors appearing less vivid: Hues may seem washed out or faded
• Hazy or gray area in central vision: In advanced stages, a persistent shadow or blind spot develops

With advanced dry AMD (geographic atrophy), a noticeable blind spot may develop in the center of vision. This can make reading extremely difficult and affect the ability to drive, recognize faces, or perform detailed tasks. The blind spot may gradually enlarge as more cells are lost.

Symptoms of Wet AMD

Wet AMD symptoms typically appear suddenly and progress rapidly, often within days to weeks. The most important warning sign is metamorphopsia – seeing straight lines as wavy, bent, or distorted. Common symptoms of wet AMD include:

• Straight lines appearing wavy or crooked: Door frames, window blinds, or lines on paper may look bent
• Distorted central vision: Faces may appear warped or asymmetrical
• Rapid loss of central vision: Vision may decline noticeably over days to weeks
• Dark or empty spot in central vision: A blind spot may appear suddenly
• Objects appearing smaller or farther away: Size and distance perception may be affected

When Should You See a Doctor for Vision Changes?

See an eye doctor immediately if you experience sudden vision changes, straight lines appearing wavy, or a new dark spot in your central vision. For gradual vision changes, schedule an appointment within 1-2 weeks. All adults over 50 should have comprehensive dilated eye exams at least every 1-2 years to detect AMD early.

Knowing when to seek care for vision changes can mean the difference between preserving and losing sight, particularly with wet AMD. While many vision changes in older adults are normal age-related changes, certain symptoms warrant urgent or immediate attention. The timing of medical care directly impacts treatment outcomes.

Routine eye exams are the foundation of AMD detection because early stages often have no symptoms. The American Academy of Ophthalmology recommends comprehensive dilated eye exams at least every 1-2 years for adults over 65, and more frequently if you have risk factors for AMD such as family history, smoking history, or cardiovascular disease.

Seek Immediate Care (Within 24-48 Hours)

Certain symptoms indicate possible wet AMD or other serious eye conditions requiring urgent evaluation:

• Sudden distortion of central vision (straight lines appearing wavy)
• Rapid decline in vision over hours to days
• New blind spot or dark area in central vision
• Sudden change in color perception
• Significant increase in existing distortion or blind spots

For these symptoms, contact your eye doctor's office immediately or go to an emergency eye care center. Many ophthalmology practices have urgent care slots or on-call services for acute vision changes. Early treatment of wet AMD significantly improves outcomes.

Schedule an Appointment (Within 1-2 Weeks)

The following symptoms suggest possible dry AMD or other progressive eye conditions that should be evaluated promptly but are not emergencies:

• Gradual blurring of central vision
• Increasing difficulty reading or recognizing faces
• Need for brighter light than usual for reading
• Colors appearing less vivid
• Difficulty adapting from bright to dim lighting

How Is Macular Degeneration Diagnosed?

AMD is diagnosed through a comprehensive dilated eye exam that includes visual acuity testing, examination of the retina, and imaging tests. Optical coherence tomography (OCT) provides detailed cross-sectional images of the retina, while fluorescein angiography can reveal abnormal blood vessels in wet AMD. The Amsler grid test helps detect and monitor distortion.

Diagnosing macular degeneration requires a thorough eye examination by an ophthalmologist or optometrist. Because early AMD often causes no symptoms, routine comprehensive eye exams are essential for detection before significant vision loss occurs. Several tests work together to diagnose AMD, determine its type and severity, and guide treatment decisions.

The diagnostic process begins with a detailed medical history, including questions about vision symptoms, family history of eye disease, smoking history, and overall health conditions. This information helps assess risk factors and guides the examination. A complete eye exam includes several components, each providing different information about eye health.

Visual Acuity Testing

Visual acuity testing measures how well you see at various distances using standardized eye charts. This test establishes a baseline measurement and tracks changes over time. For AMD, visual acuity may remain good even with significant disease if the very center of the macula is spared, which is why additional tests are necessary.

Dilated Eye Examination

During a dilated exam, eye drops are used to widen your pupils, allowing the doctor to see the retina and macula clearly using special magnifying lenses and lights. The doctor looks for drusen (yellow deposits), pigment changes, areas of atrophy, blood or fluid, and abnormal blood vessels. This examination is the foundation of AMD diagnosis.

The dilation drops take about 20-30 minutes to work fully and may blur your vision and increase light sensitivity for several hours afterward. You should arrange for someone else to drive you home or plan to wait until the effects wear off.

Optical Coherence Tomography (OCT)

OCT is a non-invasive imaging test that creates detailed cross-sectional images of the retina using light waves. This technology can detect fluid accumulation, measure retinal thickness, identify drusen, and reveal early changes in the macula that may not be visible during a standard exam. OCT is essential for:

• Detecting fluid under or within the retina (indicating wet AMD)
• Measuring the size and depth of drusen
• Identifying geographic atrophy in advanced dry AMD
• Monitoring response to treatment
• Detecting disease progression

The OCT scan takes only a few minutes and is completely painless. You simply look at a target while the machine scans your eye with low-power light. Modern OCT machines can also image the choroidal blood vessels (OCT angiography), which helps identify abnormal vessel growth without the need for dye injection.

Fluorescein Angiography

If wet AMD is suspected, fluorescein angiography may be performed. This test involves injecting a fluorescent yellow dye into a vein in your arm. As the dye circulates through the blood vessels in your eye, a special camera takes rapid photographs that reveal any abnormal blood vessels and areas of leakage.

The test takes about 20-30 minutes. After the injection, you may notice a temporary yellow tint to your skin and urine for 24-48 hours as the dye is eliminated from your body. Some people experience mild nausea during the test, and rarely, allergic reactions can occur.

Amsler Grid Test

The Amsler grid is a simple test using a grid of straight lines with a dot in the center. Looking at the central dot with one eye at a time, you note whether any lines appear wavy, blurred, distorted, or missing. This test is valuable for:

• Initial screening for macular problems
• Self-monitoring at home between appointments
• Detecting new or worsening distortion that may indicate wet AMD

How Is Macular Degeneration Treated?

Treatment depends on the type of AMD. Wet AMD is treated with anti-VEGF injections directly into the eye, which can stabilize or improve vision in up to 90% of patients. Dry AMD currently has no cure, but AREDS2 vitamin supplements can slow progression by 25% in intermediate cases. Lifestyle modifications benefit both types.

Treatment approaches for macular degeneration have advanced significantly in recent years, particularly for wet AMD. While there is no cure for either form of AMD, available treatments can slow disease progression, stabilize vision, and in some cases, improve sight. The choice of treatment depends on the type and stage of AMD, as well as individual patient factors.

The goals of AMD treatment include preserving existing vision, slowing disease progression, and maximizing quality of life. For wet AMD, treatment can be remarkably effective when started promptly. For dry AMD, management focuses on risk factor modification and nutritional supplementation in appropriate candidates, along with regular monitoring to detect progression to wet AMD.

Treatment for Wet AMD

Anti-VEGF (vascular endothelial growth factor) therapy has revolutionized the treatment of wet AMD. These medications work by blocking the protein that stimulates abnormal blood vessel growth and leakage. Anti-VEGF drugs are injected directly into the eye (intravitreal injection) and have become the standard of care for wet AMD.

Available anti-VEGF medications include:

• Ranibizumab (Lucentis): FDA-approved specifically for wet AMD
• Aflibercept (Eylea): May allow longer intervals between injections
• Bevacizumab (Avastin): Used off-label; effective and more affordable
• Faricimab (Vabysmo): Newer medication targeting two pathways; may require less frequent dosing
• Brolucizumab (Beovu): Allows extended treatment intervals in some patients

Treatment typically begins with monthly injections for the first 3 months (loading phase), followed by individualized treatment intervals based on disease activity. Some patients may require injections every 4 weeks indefinitely, while others may extend to 8-16 week intervals. Regular OCT monitoring guides treatment decisions.

What to Expect During Eye Injections

The thought of receiving an injection into the eye can be concerning, but the procedure is generally well-tolerated. Here's what typically happens:

1. Anesthetic eye drops numb the eye completely
2. The eye and surrounding skin are cleaned with antiseptic solution
3. A small speculum holds the eyelids open
4. The injection is given through the white part of the eye into the vitreous cavity
5. The entire procedure takes only a few minutes

Most patients experience minimal discomfort, often describing only mild pressure during the injection. Afterward, you may notice temporary floaters or bubbles in your vision, mild grittiness, or a small amount of redness that resolves within a few days. Serious complications such as infection or retinal detachment are rare, occurring in less than 1 in 1,000 injections.

Treatment for Dry AMD

Currently, there is no treatment that can reverse dry AMD or restore lost vision. However, several strategies can help slow progression and maintain remaining vision.

AREDS2 Supplements: The Age-Related Eye Disease Study 2 (AREDS2) demonstrated that a specific combination of vitamins and minerals can reduce the risk of progression to advanced AMD by about 25% in people with intermediate AMD or advanced AMD in one eye. The AREDS2 formula contains:

• Vitamin C (500 mg)
• Vitamin E (400 IU)
• Lutein (10 mg)
• Zeaxanthin (2 mg)
• Zinc (80 mg, some formulas use 25 mg)
• Copper (2 mg, to prevent zinc-induced deficiency)

These supplements are not beneficial for people without AMD or with only early AMD. They should only be taken after consultation with an eye doctor who can determine if you are an appropriate candidate based on your disease stage and overall health.

Emerging Treatments for Dry AMD: Several new treatments are being developed and tested for dry AMD, including:

• Complement inhibitors that target the immune pathways involved in AMD
• Gene therapy approaches
• Stem cell treatments to replace damaged RPE cells
• Visual cycle modulators

In 2023, the FDA approved pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay) for geographic atrophy, making them the first treatments available for advanced dry AMD. These medications require regular eye injections and can slow the growth of atrophy areas.

How Can You Manage Daily Life with AMD?

Living with AMD requires adapting your environment and activities to maximize remaining vision. Strategies include using magnification devices, improving lighting, increasing contrast, and learning new techniques for daily tasks. Low vision specialists can provide personalized training and recommend appropriate aids. Support groups and counseling help address emotional challenges.

Adjusting to vision loss from AMD can be challenging, but many people maintain active, fulfilling lives with appropriate adaptations and support. Because AMD affects only central vision while preserving peripheral vision, you can learn to use your remaining sight more effectively. The key is understanding your specific visual capabilities and matching them with appropriate strategies and tools.

The impact of AMD varies greatly between individuals. Some people with AMD continue driving and reading with minimal difficulty, while others require significant lifestyle modifications. Your eye doctor can refer you to low vision specialists who are experts in helping people maximize their remaining vision and maintain independence.

Practical Adaptations for Daily Life

Several straightforward modifications can make daily activities easier:

• Lighting: Use bright, direct lighting for tasks like reading and cooking. Task lights with adjustable arms are particularly helpful.
• Contrast: Increase contrast where possible, such as using dark-colored cutting boards for light foods and light boards for dark foods, or using bold-line writing paper.
• Magnification: Magnifying glasses, electronic magnifiers, and large-print materials can make reading possible.
• Technology: Smartphones and tablets offer accessibility features including text enlargement, voice control, and screen readers.
• Organization: Keep frequently used items in consistent, known locations to reduce the need for visual searching.

Low Vision Rehabilitation

Low vision rehabilitation services help people learn to use their remaining vision effectively. Services may include:

• Evaluation of visual function and needs assessment
• Training in eccentric viewing (using peripheral vision)
• Prescription and training with optical devices
• Instruction in adaptive techniques for daily tasks
• Home modifications and lighting recommendations
• Counseling and emotional support

Ask your eye doctor for a referral to low vision services. Many hospitals, eye clinics, and organizations for the visually impaired offer these programs.

Driving Considerations

Whether you can continue driving with AMD depends on your specific visual function and local regulations. Many people with early or moderate AMD retain adequate vision for driving, while others may need to limit driving to daytime hours or familiar routes, or stop driving altogether.

Your eye doctor can assess whether your vision meets legal requirements for driving and discuss any restrictions that may apply. If you need to stop driving, explore alternative transportation options such as public transit, ride-sharing services, volunteer driver programs, or paratransit services for people with disabilities.

Self-Monitoring with the Amsler Grid

Regular self-monitoring can help detect changes in your vision that may indicate disease progression or the development of wet AMD. The Amsler grid test is a simple, effective tool for this purpose:

1. Hold the grid at normal reading distance (about 12-14 inches from your eyes)
2. Wear your reading glasses if you normally use them
3. Cover one eye completely
4. Focus on the central dot with your uncovered eye
5. While looking at the dot, notice if any lines appear wavy, distorted, or missing
6. Repeat with the other eye
7. Test your vision at least once weekly, or as recommended by your doctor

If you notice any new distortion, waviness, or missing areas, contact your eye doctor promptly. Early detection of wet AMD allows for earlier treatment and better outcomes.

Can You Prevent or Slow Macular Degeneration?

While you cannot completely prevent AMD, lifestyle modifications can significantly reduce your risk and slow progression if you already have the disease. The most important steps are not smoking, eating a diet rich in leafy greens and fish, maintaining healthy blood pressure and cholesterol, exercising regularly, protecting your eyes from UV light, and getting regular eye exams.

Prevention and risk reduction are crucial aspects of AMD management because the disease progresses more easily than it can be treated, especially in its dry form. Research has identified several modifiable risk factors that, when addressed, can meaningfully reduce AMD risk and slow progression. These lifestyle factors also benefit overall cardiovascular health, which is closely linked to eye health.

While age and genetics are the strongest risk factors for AMD and cannot be changed, many other factors are within your control. Implementing healthy lifestyle habits benefits not only your eyes but your entire cardiovascular system and overall health.

Stop Smoking

Smoking is the single most important modifiable risk factor for AMD. Smokers have two to four times the risk of developing AMD compared to non-smokers, and smoking accelerates disease progression. The toxic chemicals in cigarette smoke damage the delicate blood vessels and tissues of the eye, promote inflammation, and deplete protective antioxidants.

The good news is that quitting smoking at any age reduces AMD risk. Former smokers have lower risk than current smokers, though their risk remains somewhat elevated compared to never-smokers even years after quitting. If you smoke, quitting is the most impactful step you can take for your eye health.

Nutrition for Eye Health

Diet plays a significant role in AMD risk and progression. Research consistently shows that people who eat more fruits and vegetables, particularly dark leafy greens, have lower rates of AMD. Key nutrients for eye health include:

• Lutein and zeaxanthin: Found in kale, spinach, collard greens, and other dark leafy greens. These carotenoids concentrate in the macula and help filter harmful blue light.
• Omega-3 fatty acids: Found in fatty fish like salmon, mackerel, and sardines. May reduce inflammation and support retinal health.
• Antioxidants (vitamins C and E): Found in citrus fruits, berries, nuts, and seeds. Help protect cells from oxidative damage.
• Zinc: Found in meat, seafood, beans, and nuts. Essential for retinal function.

A Mediterranean-style diet, rich in vegetables, fruits, whole grains, fish, and olive oil, has been associated with reduced AMD risk in several studies.

Cardiovascular Health

The eyes depend on healthy blood circulation, and conditions that damage blood vessels throughout the body also affect the eyes. Managing cardiovascular risk factors helps protect your vision:

• Blood pressure: High blood pressure damages blood vessels and may increase AMD risk
• Cholesterol: High cholesterol levels are associated with increased AMD risk
• Weight: Obesity increases AMD risk; maintaining a healthy weight is protective
• Exercise: Regular physical activity improves cardiovascular health and may reduce AMD risk

Protect Your Eyes from UV Light

Prolonged exposure to ultraviolet light and blue light may contribute to AMD development. Protect your eyes by wearing sunglasses that block 99-100% of UV-A and UV-B rays, along with a wide-brimmed hat outdoors. Some evidence suggests that blue-light-filtering lenses may offer additional protection, though this is still being studied.

Regular Eye Examinations

Perhaps the most important preventive measure is regular comprehensive eye exams. Early detection allows for earlier intervention and better outcomes. The recommended frequency depends on your age and risk factors:

• Adults 40-54: Every 2-4 years
• Adults 55-64: Every 1-3 years
• Adults 65 and older: Every 1-2 years
• Anyone with risk factors: More frequent exams as recommended by their doctor

What Causes Macular Degeneration?

AMD results from a combination of aging, genetic factors, and environmental influences. The disease develops when the retinal pigment epithelium cells that support the photoreceptors become damaged and accumulate waste products. Genetic factors account for 50-70% of AMD risk, while smoking, cardiovascular disease, and UV exposure contribute to the remainder.

Understanding the causes of macular degeneration helps explain why the disease occurs and guides prevention and treatment strategies. AMD is a complex condition resulting from the interplay of multiple factors, including normal aging processes, genetic predisposition, environmental exposures, and lifestyle choices.

At its core, AMD reflects age-related changes in the retinal pigment epithelium (RPE), a layer of cells that supports and nourishes the photoreceptors (rods and cones) of the retina. The RPE performs critical functions including absorbing excess light, recycling visual pigments, and removing waste products from photoreceptor cells. As we age, the RPE becomes less efficient at these tasks.

The Role of Aging

Aging is the primary risk factor for AMD. The cumulative effects of oxidative stress, reduced blood flow, and cellular waste accumulation over decades lead to RPE dysfunction. This results in:

• Drusen formation: Waste products that the RPE cannot effectively remove accumulate as drusen between the RPE and underlying tissue
• RPE damage: Oxidative stress and accumulated waste damage RPE cells, leading to their death
• Photoreceptor loss: Without functioning RPE cells, photoreceptors die, causing vision loss
• Bruch's membrane changes: The membrane between the RPE and blood supply thickens and becomes less permeable

Genetic Factors

Genetics play a substantial role in AMD, accounting for 50-70% of the disease risk. Having a parent or sibling with AMD significantly increases your risk. Several genes have been identified that influence AMD susceptibility:

• Complement factor H (CFH): The most significant genetic risk factor, involved in immune system regulation
• ARMS2/HTRA1: Another major genetic risk factor, though its exact function is still being studied
• Complement pathway genes: Several other genes in the complement immune system are associated with AMD risk

Genetic testing for AMD-associated genes is available but not routinely recommended because the results do not currently change management. However, if you have family members with AMD, inform your eye doctor so they can monitor you more closely.

Environmental and Lifestyle Factors

Several modifiable factors influence AMD risk:

• Smoking: The most significant modifiable risk factor, increasing risk 2-4 times
• Diet: Low intake of antioxidants and omega-3 fatty acids increases risk
• Sunlight exposure: Prolonged UV exposure may contribute to damage
• Cardiovascular disease: High blood pressure, high cholesterol, and obesity increase risk

Frequently Asked Questions