Overview
Age-related macular degeneration (AMD) affects the macula, the central part of the retina responsible for sharp, detailed central vision. Dry AMD (atrophic) progresses slowly and accounts for 80 to 90% of cases. Wet AMD (neovascular) involves abnormal blood vessel growth and causes rapid central vision loss if untreated. AMD is the leading cause of severe visual impairment in people over 50 in the developed world.
How common is it?
AMD affects around 600,000 people in the UK. About 1 in 10 adults over 65 has early signs. Approximately 30,000 people per year lose significant vision from AMD.
Causes and risk factors
AMD results from cumulative oxidative damage to retinal cells, choroidal blood vessel changes, and complement pathway dysregulation. Genetics and smoking are the strongest risk factors.
Common risk factors
- Age (primary risk factor)
- Smoking (doubles the risk — single most modifiable factor)
- Family history (CFH, ARMS2, and HTRA1 gene variants)
- Cardiovascular disease and hypertension
- Fair skin and blue eyes
- High dietary fat intake
- UV light exposure
- Previous cataract surgery
Symptoms
- Gradual loss of central vision (dry AMD)
- Difficulty recognising faces or reading fine print
- Straight lines appearing wavy or distorted (metamorphopsia — an early sign of wet AMD)
- Blurred or blank spot in the centre of vision
- Colours appearing less vivid
- Peripheral vision is preserved
When to see a doctor
Seek immediate ophthalmology assessment (same-day or next-day) if straight lines suddenly appear wavy, or if there is any rapid central vision deterioration. Early treatment of wet AMD (within days of symptom onset) prevents permanent severe visual loss.
Diagnosis
Fundal examination identifies drusen (characteristic deposits) and pigmentary changes. OCT (optical coherence tomography) detects fluid and structural changes. Fluorescein angiography (FFA) maps abnormal vessel growth in wet AMD. Amsler grid for home monitoring.
Treatments
Anti-VEGF injections (wet AMD)
Intravitreal injections of ranibizumab (Lucentis), aflibercept (Eylea), or bevacizumab (Avastin) block abnormal vessel growth. Given monthly or as-needed depending on disease activity. If started promptly, vision stabilises in 90% and improves in 30%.
AREDS2 supplements (dry AMD)
High-dose antioxidant supplements (vitamin C, E, zinc, copper, lutein, zeaxanthin) reduce the risk of progression to advanced dry or wet AMD by 25% in people with moderate to advanced dry AMD.
Low-vision rehabilitation
Magnifiers, eccentric viewing training, and assistive technology (screen readers, audiobooks) maximise remaining vision and independence. Referral to visual impairment services is important.
Self-care and lifestyle
- Stop smoking — most important modifiable risk factor
- Eat a diet rich in leafy green vegetables (lutein and zeaxanthin: kale, spinach), fish, and fruit
- Take AREDS2 supplements if you have moderate AMD (discuss with ophthalmologist)
- Use the Amsler grid to monitor for sudden changes in dry AMD
- Protect eyes from UV light with wraparound sunglasses
Prevention
Stopping smoking is the single most important prevention and reduces progression risk by 50%. Mediterranean-style diet and AREDS2 supplements in those with intermediate AMD reduce progression.