Age-related macular degeneration (AMD for short) is the most common cause of central vision loss in older people in the Western world. It damages the macula — the small area at the centre of the retina responsible for sharp vision — and so it takes exactly what is most needed: the ability to read, recognise faces and see detail at the centre of gaze. In this sense it is the precise opposite of glaucoma: there the damage begins at the margins, and here it is at the centre. This page explains the two forms of the disease, how it is monitored, and how it is treated.
What happens in the macula
The retina captures light across the whole visual field, but only a small area at its centre — the macula — provides the sharp vision used for reading and recognition. In macular degeneration, an age-related process damages the macula: deposits called drusen accumulate in it, the layers beneath it weaken, and central vision begins to blur and distort. The peripheral field, by contrast, remains intact — which is why the disease almost never causes total blindness, but severely harms the daily function that depends on central vision.
The two forms
Dry (atrophic) macular degeneration is the common form, around 90% of cases. It develops slowly over years: the drusen accumulate and the central tissue gradually thins, up to an advanced state called geographic atrophy — areas in which the retinal cells simply disappear. Central vision weakens slowly, often in one eye before the other.
Wet (neovascular) macular degeneration is less common but far more aggressive. New, fragile blood vessels grow beneath the macula, leak fluid and blood, and cause distortion and central vision loss that can develop within days to weeks. The wet form is responsible for the lion’s share of severe vision loss in AMD. It is important to know: any dry degeneration can turn wet at any stage, so a sudden change in vision is not something to wait on.
The symptoms and the Amsler grid
The first signs are at the centre of vision: blur, a greyish or empty patch at the centre, and growing difficulty with reading and recognising faces. The characteristic sign of the wet form is distortion — straight lines that appear wavy or broken, a window frame or a line of text that bends.
The simple tool for monitoring is the Amsler grid: a grid of squares with a dot at the centre, looked at with one eye at a time. If the lines appear distorted or missing, or a spot appears — that is a warning sign requiring prompt examination, especially because of the possibility of a switch to a wet form. Regular home monitoring is the way to catch the change at the time when treatment is most effective.
Who is at risk
The most significant factor is age — the risk clearly rises above 60. After it, smoking is the most important controllable risk factor, and it doubles the risk. Other factors are a family history and genetic background, Western European ancestry, a diet poor in leafy vegetables and omega-3, obesity and cardiovascular disease. Stopping smoking and eating well are among the few steps genuinely in the patient’s control.
How it is diagnosed
- A dilated fundus exam — to identify drusen, pigment changes and areas of atrophy.
- OCT imaging — the central test: a cross-section of the macula that detects fluid (a sign of a wet form), drusen and atrophy, and allows precise tracking of the response to treatment.
- Angiography (FA or OCT-A) — showing new vessels and leakage, and confirming a wet form.
Treatment
Treatment depends on the form, and its aim is to preserve the vision that remains:
In the wet form — anti-VEGF injections. This is the mainstay: injections into the eye that stop the leakage from the new blood vessels. They are given in a series, at intervals set by the response, and often succeed not only in stabilising but also in recovering some of the vision lost — provided they are started early.
In the dry form — preventing progression. There is no drug that restores vision, but AREDS2 supplements — a defined combination of vitamins and minerals — reduce the risk of progression from the intermediate to the advanced stage. Recently, injectable drugs for geographic atrophy (the advanced stage of the dry form) have also been approved, which slow the rate of the lesion’s spread by about 14% to 20% — but it is important to understand that they only slow it, and do not improve or restore vision. Stopping smoking helps at every stage.
Living with macular degeneration
Because the disease spares the peripheral field, patients keep the ability to orient in space and walk safely, even when central vision is severely harmed. The main difficulty is in reading and recognising faces, and here visual aids help — magnifiers, strong lighting, text enlargement and assistive devices. Early detection, monitoring with an Amsler grid and timely treatment are what determine how much central vision is preserved.
For background on other retinal diseases see diabetic retinopathy and eye diseases; on an eye disease that strikes the margins instead, see glaucoma. Because the disability rating is derived from the remaining visual acuity, the framework can be seen on eye disability assessment.
Bottom line
Age-related macular degeneration takes central vision and leaves the peripheral — so it harms reading and recognising faces but almost never ends in total blindness. The distinction between the dry, slow form and the wet, rapid one determines the treatment: anti-VEGF for the wet, supplements and new drugs to slow the dry. The most important practical thing is monitoring — a periodic exam from age 60 and an Amsler grid at home — because in the wet form, every week counts.
The information on this page is general and not a substitute for a personal examination and medical advice. Anyone noticing distortion or sudden blur at the centre of vision is welcome to be examined promptly by an ophthalmologist.
Frequently asked questions
What is macular degeneration?
Age-related macular degeneration (AMD) is damage to the macula — the central area of the retina responsible for sharp vision. It harms what is at the centre of the visual field: reading, recognising faces, driving — and spares the peripheral field, so a person with advanced macular degeneration can still find their way around but struggles to see what they look at directly. It is the common form of central vision loss from age 60 onwards.
What is the difference between dry and wet macular degeneration?
The dry form is the common one, and it develops slowly: deposits (drusen) accumulate and the central tissue thins, up to geographic atrophy at an advanced stage. The wet form is less common but more aggressive: new, fragile blood vessels grow beneath the retina, leak and bleed, and cause distortion and rapid central vision loss. Any dry degeneration can turn wet, so a sudden change in vision requires an urgent examination.
What is the Amsler grid and why does it matter?
The Amsler grid is a simple grid of squares with a dot in the centre, used for self-monitoring at home. You look at the dot with one eye at a time: if the straight lines appear distorted, wavy or missing, or a spot appears at the centre — that is a warning sign, especially for the wet form, and requires prompt attention from an ophthalmologist. This home monitoring can catch the switch to a wet form at the stage where treatment is most effective.
Can macular degeneration be treated?
Yes, though treatment depends on the type. In the wet form, anti-VEGF injections into the eye are the mainstay, and they often stabilise and even improve vision. In the dry form, AREDS2 supplements reduce the risk of progression to an advanced stage, and injectable drugs for geographic atrophy have recently been approved that slow the growth of the lesion — but do not restore vision already lost. Stopping smoking is among the most significant steps in either form.
