Age-related macular degeneration (AMD): Causes, symptoms and treatments
What is age-related macular degeneration?
Age-related macular degeneration (AMD) is an eye condition affecting central vision. It causes blurry vision and other visual symptoms that may develop gradually or suddenly. In adults aged 50 and over, macular degeneration is a top cause of irreversible vision loss.
AMD affects the macula — the small round structure in the center of the retina — which is located in the back of the eye. The macula plays a crucial role in your vision. It maintains your sharpest central vision, allowing you to see fine details when you look directly at something.
The health of the macula helps determine your ability to see color and perform detailed visual tasks, such as:
- See and read written text
- Recognize faces
- Drive a car
- Cook and perform other household activities
- Watch television
- Use a digital device
A person with AMD eye disease loses central vision but typically maintains peripheral (or side) vision. It can occur in one or both eyes and may affect each eye differently.
As a progressive condition, age-related macular degeneration tends to worsen over time. However, blindness is rare in AMD.
Types of age-related macular degeneration: Dry vs. wet
There are two primary types of age-related macular degeneration: dry AMD and wet AMD. Each variation of this degenerative eye disease carries unique characteristics.
Click on image to enlarge.
Dry AMD (also called non-exudative, non-neovascular or atrophic AMD) is the more common form of macular degeneration, affecting 85%-90% of AMD patients. It is called “dry” macular degeneration since it does not involve blood vessel leakage, as seen in the wet form. (Dry AMD is not the same as dry eye, which is a different type of eye condition.)
Age-related macular degeneration typically begins as dry AMD.
Dry age-related macular degeneration involves the gradual thinning and breakdown of the macula. It is associated with yellow-colored deposits beneath the macula called drusen. These deposits are accumulations of proteins and fatty substances. (The presence of drusen does not always indicate macular degeneration. However, having a higher amount of these deposits can lead to the development of AMD eye disease.)
Many individuals with dry age-related macular degeneration notice a gradual loss of vision that progresses with time. People with dry AMD can develop wet AMD.
Central vision loss tends to occur more slowly with dry age-related macular degeneration.
Characteristics of wet AMD
Wet AMD (also called exudative or neovascular AMD) is the more visually threatening form of the condition. It accounts for 10%-15% of AMD cases. Wet AMD is responsible for 80%-90% of severe cases of vision loss resulting from age-related macular degeneration.
Wet macular degeneration is caused by leaking blood vessels under the retina. New or abnormal blood vessels may develop and leak fluids or blood into the back of the eye, damaging the macula. In wet AMD, this growth of new blood vessels is called choroidal neovascularization.
People with wet AMD typically experience more significant central vision loss than those with dry AMD.
Wet age-related macular degeneration can have a sudden onset. Vision loss tends to occur more quickly with this type of AMD and can even develop over the course of a few days to several weeks.
Signs and symptoms of age-related macular degeneration
The symptoms of macular degeneration can vary according to the disease stage. They can also differ from one person to the next. Pain is not usually an AMD symptom.
Early warning signs
Many people with AMD disease do not notice any symptoms in the early stages. Often, symptoms do not become apparent until the condition has progressed. However, some research shows that the slowing of rod-mediated dark adaptation (RMDA) may be an early indicator of AMD onset or progression. Sometimes called the “dark theater effect,” this refers to the eyes taking longer to adjust when entering a dark space after being in bright light.
Age-related macular degeneration symptoms typically become more obvious to people in the intermediate stage. They often involve signs of vision loss and may include:
- Dark or shadowy areas in your central vision
- Scotoma (blind spots in your field of vision)
- Unusually fuzzy or blurry vision
- Metamorphopsia (distorted vision)
- Straight lines look wavy or bent
- Difficulty seeing details in poor lighting conditions
- Changes in color vision
Progression of symptoms
In some instances, dry or wet AMD may only affect one eye. Age-related macular degeneration may also progress differently in each eye. This means that each eye may experience different stages of the disease.
Many patients do not notice the symptoms of AMD disease if they are present in only one eye. This may also be the case if symptoms are more pronounced in one eye than the other.
Symptoms, such as blind spots and vision distortion, are often signs of late-stage AMD.
Stages of AMD
Dry macular degeneration is categorized into three stages:
- Early – The initial stage of AMD eye disease typically causes no symptoms or vision changes.
- Intermediate – As the disease progresses, blurry areas may develop in your central field of vision. You may also find it more difficult to see clearly in dim lighting.
- Advanced – During the advanced stage of dry age-related macular degeneration, also called geographic atrophy (GA), you may experience blurry, missing or wavy areas in the center of your vision. This may gradually lead to a total loss of central vision.
Dry age-related macular degeneration can develop into wet AMD at any stage. When wet macular degeneration occurs, however, it is considered to be the advanced stage of the condition. Wet AMD usually progresses faster and almost always begins as dry AMD.
Click image to view how the different types of macular degeneration may present.
What causes age-related macular degeneration: Who is at risk of AMD?
While the precise cause of AMD eye disease is unknown, researchers believe that a range of factors may contribute to its development. Vision concerns caused by this degenerative eye disease can vary among individuals.
Macular degeneration can affect anyone. However, certain factors can increase the risk of developing the condition. These may include:
Age
As its name implies, age-related macular degeneration becomes more of a risk with age. The severity of vision loss from the condition also tends to increase over time. Those over age 50 have a greater chance of developing AMD.
Genetic factors
Age-related macular degeneration is associated with aging and other factors, but there may also be a genetic component. Researchers have noted strong associations between AMD and two gene variants.
Having a genetic predisposition to AMD does not mean you will automatically develop it. However, it can increase your risk of experiencing the disease.
If one of your parents has AMD, your chances of developing the condition are nearly twice as high as someone without a genetic predisposition.
Sex
Age-related macular degeneration affects more women than men. This may be due in part to women having a longer life expectancy than men, among other factors.
Women also tend to experience the onset of AMD eye disease at a younger age than men.
Ethnicity
Among U.S. adults, AMD is more prevalent in the white population. Individuals of white (non-Hispanic) ethnicity have a higher likelihood of developing the disease when compared to other racial groups.
Health factors
Specific health issues have been linked to AMD eye disease and may increase a person’s risk of having the condition. These health concerns may include:
- Heart disease
- Hypertension (high blood pressure)
- High cholesterol
- Inflammation and immune response
- Obesity
Environmental and lifestyle factors
Certain environmental and lifestyle factors may increase the risk of AMD, including:
- Smoking – Smoking cigarettes can quadruple a person’s chances of developing AMD. It is a significant risk factor for this eye condition.
- Sedentary lifestyle – Inadequate amounts of exercise can affect heart health and potentially increase the risk of AMD eye disease.
- Diet – The link between diet and AMD largely centers around oxidative stress, an imbalance in the body that can cause tissue damage. Eating a diet high in saturated fat, sugars and sodium or low in fiber, protein, vitamins and antioxidants may lead to oxidative stress, which could increase the risk of AMD development.
- Ultraviolet (UV) light – People with a history of more UV light exposure may be at a higher risk for macular degeneration, as UV light is thought to damage the retina. Some researchers believe that over-exposure to sunlight may also be a contributing factor in the development of the disease. However, this theory has not been proven conclusively.
How is AMD diagnosed?
Comprehensive eye exams can help detect the condition as early as possible. This is especially important since the early stage of dry age-related macular degeneration generally does not cause noticeable symptoms, and even some cases of intermediate dry AMD may not produce symptoms.
An ophthalmologist or optometrist may use one or more of the following tests and techniques to help diagnose and monitor age-related macular degeneration:
- Visual acuity test – A visual acuity test helps measure how clearly you can see. It typically involves reading letters on a chart positioned at a specific distance.
- Amsler grid test – This test involves looking at a grid of intersecting lines with a black dot in the center. If the lines in the grid appear wavy, broken or distorted, it could indicate changes in your central vision.
- Dilated eye exam – A dilated eye exam involves special drops that widen the pupils, giving your eye doctor a broader view of the retina and other structures within your eyes.
- Fluorescein angiography (FA) – A special dye called fluorescein is injected into your arm. As the dye travels through your bloodstream, a camera captures images of the eye to identify any blood vessel leakage under the macula.
- Fundus autofluorescence (FAF) imaging – When parts of the retina are exposed to specific wavelengths of light, they naturally light up (or fluoresce). Eye specialists can use the results of this imaging to monitor the health of the retina and the progression of macular degeneration.
- Optical coherence tomography (OCT) or optical coherence tomography angiography (OCTA) – The OCT device takes images of the back of the eye as you look into the machine. OCTA differs slightly in that it uses laser light reflection, as well as the OCT device, to show how blood flows through the vessels in the eye.
- Patient-operated OCT – This technology may allow people with AMD to perform OCT scans at home, potentially helping their eye doctor monitor retinal changes between office visits. This may help identify changes that warrant further diagnostic evaluation.
- Dark-adaptation testing – This diagnostic tool may help detect early AMD by measuring how quickly the eyes regain visual sensitivity after bright light exposure. Delayed dark adaptation may be a sign of early AMD.
An Amsler grid consists of straight lines, with a reference dot in the center.
Someone with macular degeneration may see lines in an Amsler grid as wavy or blurred, with dark areas at the center.
AMD treatments
While there is no cure for age-related macular degeneration, vision impairment and the severity of symptoms may be decreased with early diagnosis and treatment. Some treatments may slow, delay or prevent its progression. Certain AMD treatments may also improve or stabilize a person’s vision.
Treatments for macular degeneration depend on whether the disease is in its earlier-stage dry form or the more advanced wet form. Treatment may also vary according to individual needs and other factors.
Treatment for dry AMD
Treatment options for early-stage dry macular degeneration are limited at this time. Taking certain antioxidant vitamins and minerals may help reduce the risk of dry macular degeneration progressing to wet AMD. A research study known as the Age-Related Eye Disease Study 2 (AREDS2) found that a specific formulation of supplements may help lower the risk of advanced AMD by 25%.
The AREDS2 formulation includes:
In 2026, another AREDS formulation became available, which has a refined formula including several B vitamins. Your eye doctor can determine if antioxidant therapy with nutritional supplements might be beneficial for you.
Photobiomodulation (red light therapy) may be a treatment option for some people with early or intermediate dry AMD. It uses targeted light therapy to support and improve cellular function in the retina.
Two medications are FDA-approved to treat the advanced form of dry AMD (geographic atrophy). Pegcetacoplan and avacincaptad pegol (ACP) are injectable treatments administered directly into the eye.
Treatment for wet AMD
For wet AMD, the goal of many treatments is to shrink or stop abnormal blood vessel growth and prevent the leakage of fluid into the retina. Wet or neovascular age-related macular degeneration treatments may include:
- Anti-vascular endothelial growth factor (anti-VEGF) injections – Involves the injection of a medication (such as aflibercept, bevacizumab, brolucizumab, faricimab or ranibizumab) into the affected eye. These injections, known as anti-VEGF therapy, help control the leakage and abnormal growth of blood vessels in the back of the eye.
- Port delivery system – A refillable eye implant device continuously delivers anti-VEGF medication. The device’s reservoir is periodically refilled with the drug. (This system was designed for ranibizumab. However, the use of other drugs is currently being studied).
- Laser photocoagulation – Uses an intense light beam to close off and eliminate leaking blood vessels.
- Photodynamic therapy – Combines laser technology and a special medication that’s injected into the arm. After the injection, a laser is then focused onto the eye. When exposed to the laser’s light, the medication creates blood clots in the abnormal macular blood vessels to seal them off.
- Implantable miniature telescope (IMT) – An additional treatment option for some patients with end-stage AMD. Surgically placed in the eye, this device magnifies images to help improve vision.
Other methods of treating wet and dry macular degeneration are currently under investigation.
Research and emerging treatments
Vision scientists are exploring new methods of diagnosing, treating and managing AMD. While further research is needed, some of these emerging technologies include:
- Gene therapy – The goal of this approach is to help the eye produce anti-VEGF on its own, potentially reducing or eliminating the need for ongoing eye injections.
- New drug targets and pathways – Medications targeting new or multiple pathways involved in the disease process could potentially reduce the need for frequent eye injections.
- Longer-acting medications – Medications that provide longer-lasting effects may potentially extend the timespan between eye injections.
- Cell-based therapies – This involves replacing retinal cells damaged by AMD with healthy stem cells.
- Augmented reality (AR) glasses and retinal implants – Researchers are exploring how these technologies might work together to restore some central vision in people with AMD.
Complications of AMD
The main complication of age-related macular degeneration is central vision loss. As the disease progresses, central vision gradually decreases, potentially leaving only side (peripheral) vision. This can make normal activities, like reading, driving and distinguishing images, difficult. People with severe or late-stage AMD eye disease could be considered legally blind.
AMD may also lead to other eye-related complications. These can include:
- Subretinal hemorrhage (bleeding in or around the macula)
- Vitreous hemorrhage (blood in the vitreous humor)
- Exudative retinal detachment (the retina becomes detached due to leaking blood vessels)
- Diplopia (double vision)
Studies have reported that up to 40% of people with AMD may experience Charles Bonnet syndrome. This condition involves visual hallucinations associated with vision loss.
Other complications that can arise from AMD are mental health issues, including depression and anxiety. Vision loss from AMD can affect a person’s ability to function as they used to, which may contribute to an increased risk of experiencing mental health conditions.
Further complications include the risk of falls or injuries due to vision loss.
When to see an eye doctor
If you notice sudden or gradual changes in your central vision, or any other AMD symptoms, it is recommended that you visit your eye doctor as soon as possible. Yearly comprehensive eye exams are also typically recommended as part of preventive care. They can help identify conditions, like macular degeneration, in the early stages or before symptoms develop.
Regular eye exams are also essential for monitoring the health of AMD eyes and detecting vision changes. During the exams, your eye doctor can also answer questions or address concerns you have about AMD’s effect on your eye health.
Questions asked by patients with AMD eye disease commonly include:
- What is macular degeneration?
- What is AMD eye disease?
- What are the symptoms of macular degeneration?
- What causes macular degeneration?
- Is macular degeneration inherited?
- Is macular degeneration progressive?
- How is AMD treated?
Living with macular degeneration
An AMD diagnosis can bring a range of challenges to daily life. Taking steps to adapt to its effects and make the most of your remaining vision can help you maintain your independence.
Lifestyle changes
Your eye doctor may discuss certain lifestyle changes to help manage the condition and protect your vision and eye health. Some of these may include:
- Adopting healthy dietary habits
- Quitting smoking
- Exercising regularly
- Maintaining a healthy weight
- Keeping blood pressure, cholesterol and blood sugar in healthy ranges
- Protecting your eyes against UV exposure
In some cases, lifestyle changes may also involve having someone help you with daily activities, such as cooking and driving.
Low vision aids
Low vision aids — such as magnifiers, telescopes and apps on digital devices — can help maximize your vision potential following vision loss. Large-print products may also be available for further accessibility.
Low vision aids contribute to quality-of-life improvements for many people with long-term vision loss.
Support and resources
Getting the appropriate care and support is a key factor for living with AMD. This can include:
- Attending all eye care and medical visits
- Connecting with AMD support groups (either local or online)
- Seeking mental health support from professionals, family members and friends
Prevention of AMD
Gaining an awareness of AMD and understanding your personal risk factors may be the first step in preventing the condition. Maintaining a healthy lifestyle, such as getting regular exercise, eating a balanced diet and avoiding tobacco use, might help inhibit its development.
Comprehensive eye exams also play an important role in AMD prevention and reducing the risk of permanent vision loss. Find an eye doctor near you to schedule a comprehensive eye exam and learn more about age-related macular degeneration.
If you have vision loss or other macular degeneration symptoms and are already seeing a retina specialist, consider consulting an eye doctor who specializes in low vision rehabilitation. Low vision specialists can evaluate your vision and your daily needs to maximize function.
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