Age-related macular degeneration, usually called AMD, affects the macula, a tiny but critical area at the center of the retina. Reading, recognizing faces, seeing fine detail, driving: all of these depend on the macula. AMD doesn’t cause total blindness because side vision stays intact (unlike glaucoma, which can affect peripheral vision), but it can take away precisely the vision you rely on most. It is the leading cause of permanent vision loss in people over 60 in developed countries. For a full overview of conditions affecting the central retina, see the retina subspecialty page. Caught early, it is far more manageable than most people realize.

What Is the Macula and Why Does It Matter?

The macula is a small, highly specialized area at the very center of the retina, roughly the size of a pinhead. It contains the highest concentration of cone photoreceptors in the entire eye. When you read a word, look at someone’s face, or thread a needle, you are entirely dependent on your macula.

AMD causes the cells of the macula and the supporting layer beneath it, the retinal pigment epithelium (RPE), to break down over time. Side vision is preserved because only the macula is affected. People with advanced AMD often describe looking at someone’s face and finding a blurred or dark patch right where the face should be, while their side vision remains completely clear.

Dry AMD

What happens

Dry AMD is the more common form. It develops slowly over years as tiny deposits called drusen accumulate beneath the RPE and interfere with the nourishment of the overlying photoreceptors. Over time these cells die in a process called geographic atrophy. Central vision slowly dims and distorts as atrophy spreads.

Symptoms

Early dry AMD often causes nothing noticeable at all. As it progresses, you might need more light to read fine print, find that colors look slightly less vivid, or notice straight lines appear faintly wavy. In more advanced stages a blurred or greyed-out patch appears in central vision and slowly grows. Side vision remains unaffected throughout.

Treatment

No treatment reverses dry AMD or restores cells already lost. For people with intermediate AMD or advanced AMD in one eye, AREDS2 supplements (a specific combination of vitamins C and E, lutein, zeaxanthin, and zinc) reduce the risk of progression to advanced AMD by around 25 percent. These are not standard multivitamins: they require a specific formulation. Ask your ophthalmologist whether you qualify.

In 2023, pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay) became the first treatments approved to slow geographic atrophy in dry AMD. Both are given by injection into the eye. They slow rather than halt or reverse atrophy, but they represent a real step forward for patients with this stage of the disease.

Wet AMD

What happens

Wet AMD, also called neovascular AMD, occurs when abnormal new blood vessels grow from beneath the retina, push through the RPE, and leak fluid or blood directly into the macula. These vessels are fragile and poorly formed. The leakage can distort and damage central vision within days to weeks. Wet AMD can develop from dry AMD at any stage, including early dry AMD with few symptoms. Any sudden change in vision needs reporting the same day.

Symptoms

Straight lines appearing wavy or distorted. A blurred or dark area in the center of vision. Colors looking different in one eye compared to the other. These changes can develop over days rather than months. If you have AMD and notice any of these, do not wait for your next appointment.

Treatment

Wet AMD is treated with anti-VEGF injections, medications injected into the vitreous cavity that block the abnormal vessel growth and reduce fluid leakage. Before these existed, wet AMD almost always led to severe permanent vision loss. Today, with regular treatment, most patients maintain their vision and some improve meaningfully. Treatment starts with monthly injections for the first three months, then moves to a maintenance schedule based on OCT scan findings at each visit. Many patients need injections for years. Stopping treatment often leads to fluid returning and vision declining.

Risk Factors

Age

AMD is rare before 55, affects around 2 percent of people aged 55 to 64, and rises to around 12 percent of people over 80. Regular eye examinations become increasingly important as you get older, even when your vision feels completely normal.

Smoking

Smoking approximately doubles the risk of developing AMD. The elevated risk persists for years after stopping, but quitting is still the most impactful lifestyle change anyone at risk of AMD can make. If you smoke and AMD runs in your family, this is particularly important.

Family history and genetics

Having a first-degree relative with AMD increases personal risk by four to seven times. If AMD runs in your family, earlier and more frequent eye examinations are appropriate. Our genetics and eye disease page explains more about heredity and AMD risk.

Other factors

Light-colored eyes and fair skin are associated with modestly higher risk. UV exposure may play a role, and wearing UV-blocking sunglasses outdoors is a sensible habit. A diet low in leafy green vegetables and oily fish, and high blood pressure, are also associated with increased risk.

Diagnosis

What the ophthalmologist looks for

AMD is diagnosed through a dilated eye examination. An OCT scan gives a detailed cross-sectional image of the macular layers, revealing fluid, drusen, and atrophy with far more precision than photographs alone. Fundus photography documents how the macula looks and allows comparison over time. Fluorescein angiography is used in wet AMD to characterize new vessel growth when the OCT picture is complex.

Staging AMD

AMD is classified as early, intermediate, or advanced based on drusen size and number and the presence of geographic atrophy or choroidal neovascularization. The stage determines how often you need monitoring and whether AREDS2 supplements are indicated. Early AMD with small drusen and no symptoms requires annual review. Intermediate AMD warrants both supplements and more frequent visits. Advanced AMD in one eye puts the other eye at much higher risk.

Living With AMD

Low vision support

For patients whose central vision has been badly affected, low vision services provide practical help. Magnifying glasses, electronic magnifiers, screen readers, large-print materials, high-contrast lighting: these tools make a real difference to daily independence. Many people with advanced AMD are surprised by how much they can still do with the right support. Ask your ophthalmologist for a referral if you’re struggling.

Driving

AMD affects the ability to drive once central vision falls below the legal minimum, typically around 20/40 in the better eye. For patients receiving anti-VEGF treatment, vision often remains above the driving threshold. If you are uncertain whether your vision meets the legal standard, discuss it with your ophthalmologist and inform your licensing authority as required.

Emotional impact

An AMD diagnosis can be frightening. Anxiety and depression are common in people with AMD and are often undertreated. Support groups, patient organizations such as the Macular Society, and psychological support services can all genuinely help. Telling your ophthalmologist you’re struggling emotionally is as important as telling them about your visual symptoms.