Age-related macular degeneration (AMD) is an eye condition that causes a person’s central vision to become blurry. It usually affects people over the age of 60 years. It can worsen over time but does not usually lead to total vision loss.
Macular degeneration affects the retina, a layer at the back of the eyeball that contains light-sensitive cells that enable a person to see.
Reading, writing, recognizing faces, and driving can become more difficult with AMD. However, a person usually maintains enough peripheral vision for other daily activities. Total vision loss is unlikely.
This article looks at the types, symptoms, and treatment for AMD.
What are the types of AMD?
AMD can be wet or dry.
Dry AMD, also known as atrophic AMD, develops gradually. This type accounts for 85–90% of AMD cases.
Wet, or exudative, AMD — also known as advanced neovascular AMD — happens when new blood vessels develop under the macula. These can cause blood and fluid to leak. Wet AMD tends to progress more quickly and results in more severe vision loss.
In 10–15% of people with AMD, the dry form progresses to the wet form. This can happen at any stage of dry AMD.
Juvenile macular degeneration can affect younger people. It stems from a genetic condition.
Learn more about the difference between wet and dry AMD.
What are the symptoms of AMD?
Doctors do not consider wet AMD to have an early or intermediate stage. They regard wet AMD as advanced stage AMD. In the advanced stage, symptoms are the same for wet and dry AMD.
The table below shows how symptoms can affect a person.
| Dry AMD | Wet AMD | |
|---|---|---|
| Early stage | no symptoms | — |
| Intermediate stage | no symptoms or mild symptoms such as: • blurriness • difficulty seeing in low light • straight lines looking wavy | straight lines looking wavy |
| Advanced stage | • blurring or blank spots in the central vision • straight lines looking wavy or crooked • colors looking faded • difficulty seeing in low light | same as for dry AMD |
Learn more about what AMD looks like.
What causes AMD?
Doctors do not know exactly why AMD occurs, but genetic and environmental factors, including oxidative stress, may play a role.
Features of AMD include:
- changes in pigmentation
- drusen, which are fat deposits that appear as pale yellow spots on the retina
- a thickening of Bruch’s membrane, a layer between the retina and the choroid
- basal laminar deposits on the retina consisting of collagen fibers and other substances
- a thinning of the retina around the macula (in dry AMD)
- rapid and incorrect formation of new blood vessels (in wet AMD), leading to:
- lesions
- scarring
- exuding of fluid
- internal bleeding
More research into the causes of these features may help medical professionals better understand the condition.
What are the risk factors for AMD?
Factors that may increase AMD risk include:
- being older than 60 years
- having a family history of AMD, as 15–20% of those with AMD have a close relative who also has it
- high blood pressure
- obesity
- a diet that is high in fat and processed meats
- a low intake of certain nutrients, such as antioxidants and zinc
- exposure to UV rays, such as from sunlight
There is some evidence that AMD and cardiovascular disease (CVD) share some risk factors. Scientists are not entirely sure what links them. However, lifestyle habits that reduce CVD risks may also help reduce the risk of AMD.
How do doctors diagnose AMD?
If vision problems start to occur, a person should contact an optometrist or ophthalmologist.
The doctor may give the person some eye drops to dilate the pupil and then examine the eye.
They may also recommend:
- Optical coherence tomography: During optical coherence tomography, special light rays scan the retina and take an image. The image can show whether the macula has any unusual features.
- Amsler grid: The person looks at a grid with vertical and horizontal lines. If AMD is present, some of the lines on the grid may seem distorted, broken, or faded. A person can also use the Amsler grid to check their vision daily.
- Fluorescein angiography: If they suspect wet AMD, the doctor may recommend fluorescein angiography. During this procedure, the doctor injects a dye into the person’s arm, examines their eyes with a camera, and can take pictures of the eyes that show whether the blood vessels behind the macula are leaking.
What are the treatments for AMD?
Treatment for AMD cannot restore vision, but it can slow down vision loss.
Dry AMD
Treatments for dry AMD can depend on the type. Recent treatments for dry AMD with geographic atrophy include pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay).
A doctor injects medication directly into the eye either once per month or every 2 months. These medications slow down the immune response to help prevent damage to retinal cells.
Other tips that may help a person living with dry AMD include:
- choosing large-print books or increasing the font size on screens
- using magnifying devices
- changing the lighting
Wet AMD
Some treatments can help slow the progression of wet AMD. One example is anti-vascular endothelial growth factor medication, a chemical that contributes to the formation of new blood vessels in the eyes.
Photodynamic therapy, a type of laser treatment, may also help treat wet AMD.
Learn more about treatments for wet AMD.
Stem cell therapy
Some recent studies have suggested that human stem cells might enable the retina to repair itself one day.
In one 2018 study, two people with very severe wet AMD had significant improvements in their vision after stem cell therapy.
And in 2022, the National Institutes of Health reported that the first person in the United States had received autologous stem cell therapy to treat dry AMD.
However, this type of treatment is still in the research phase and is not widely available.
Learn about gene therapy for macular degeneration.
Implantable miniature telescope (IMT)
IMT treatment might improve the vision of people with advanced AMD. It involves implanting a small device to help a person recover some vision and have more independence.
However, the person would not regain their full field of vision or be able to drive a car.
More research into IMT is necessary.
Home and natural remedies
A 2020 review suggests that some herbal and natural remedies may help prevent AMD, although there is not enough evidence to show that they will make a difference. They are also not approved by the Food and Drug Administration (FDA).
For a person with AMD in one eye, dietary supplements may help prevent or slow the development of AMD in the other eye.
AREDS 2 supplements consist of a special formulation for people who have or are at risk of AMD.
They containTrusted Source:
- vitamin C
- vitamin E
- beta carotene
- zinc
- cupric oxide (copper)
- lutein
- zeaxanthin
A person should contact their doctor for advice before taking supplements.
Learn more about supplements for AMD.
What are the possible complications of AMD?
Possible complications of AMD include a higher risk of falls and an inability to carry out daily activities, including driving.
However, rehabilitation and support are available for people with AMD. A low vision specialist can help people learn how to use their remaining vision to its maximum potential in their daily activities.
Is it possible to prevent AMD?
It is not always possible to prevent AMD, but a person may be able to reduce the likelihood by:
- getting enough regular physical activity or exercise
- avoiding risk factors for CVD, as there may be a link
- quitting or avoiding smoking
- having regular eye tests
- wearing sunglasses that block UV rays to protect the eyes from damage
- consuming plenty of fruits, vegetables, and fish
The authors of a 2021 review found evidence that increasing the intake of omega-3 polyunsaturated fatty acids, particularly docosahexaenoic acid and eicosapentaenoic acid, may reduce the risk of an early subtype of AMD.
Frequently asked questions
Here are some frequently asked questions about AMD.
What are the early warning signs of AMD?
The first sign of AMD is usually blurry vision or changes to central vision. A person may not notice any changes in the early stages, but an eye test may detect them.
What does a person see with macular degeneration?
Macular degeneration may cause blurriness in the early stages. As the condition progresses, a person may notice blank spots, wavy lines, and faded colors.
Video: What is AMD?
The video below explains what macular degeneration is and how it affects vision.
Summary
Age-related macular degeneration (AMD) is an eye condition that can affect central vision. It is common among older adults. A person with AMD will not have complete vision loss, but they will have more difficulty reading, driving, and doing other daily tasks.
Dry AMD is the most common type. It progresses slowly and happens as the macula gets thinner.
Wet AMD can progress quickly. It happens when blood vessels in the back of the eye start to develop incorrectly.
Anyone who notices changes in their vision should consult an eye doctor. The doctor can order tests to confirm the diagnosis and advise on a suitable treatment plan.