Macular Degeneration

Dry  amd showing  geographic atrophy and scarring without bleeding.


This section  is for  people with age-related macular degeneration (AMD) and their families  and friends. It provides information about AMD and answers questions  about its causes and symptoms. Diagnosis and types of treatment are  described.  The information in this section has been  obtained from the   NEI website

The National Eye Institute (NEI) conducts  and supports research that leads to sight-saving treatments and plays a  key role in reducing visual impairment and blindness. The NEI is part of the National Institutes of Health (NIH), an agency of the U.S. Department of Health and Human Services.


What is age-related macular degeneration?


Age-related macular degeneration (AMD) is a disease that blurs the sharp, central vision you need for  "straight-ahead" activities such as reading, sewing, and driving. AMD  affects the macula, the part of the eye that allows you to see fine  detail.  AMD causes no pain.

In some cases, AMD advances so slowly  that people notice little change in their vision. In others, the disease  progresses faster and may lead to a loss of vision in both eyes. AMD is  a leading cause of vision loss in Americans 60 years of age and older.

What is wet AMD?


Wet AMD occurs when  abnormal blood vessels behind the retina start to grow under the macula.  These new blood vessels tend to be very fragile and often leak blood  and fluid. The blood and fluid raise the macula from its normal place at  the back of the eye. Damage to the macula occurs rapidly.

With wet AMD, loss of central vision can occur quickly. Wet AMD is considered to be advanced AMD and is more severe than the dry form.

An early symptom of wet AMD is  that straight lines appear wavy. If you notice this condition or other  changes to your vision, contact your eye care professional at once. You  need a comprehensive dilated eye exam.

What is dry AMD?


Dry AMD occurs when the  light-sensitive cells in the macula slowly break down, gradually  blurring central vision in the affected eye. As dry AMD gets  worse, you may see a blurred spot in the center of your vision. Over  time, as less of the macula functions, central vision in the affected  eye can be lost gradually.

The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces. You may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected.

One of the most common early signs of dry AMD is drusen. Drusen are yellow deposits under the retina. They often are  found in people over age 60. Your eye care professional can detect  drusen during a comprehensive dilated eye exam.

Dry AMD has three stages, all of which may occur in one or both eyes:

  1. Early AMD. People with early AMD have either several small drusen or a few medium-sized drusen. At this stage, there are no symptoms and no vision loss.
  2. Intermediate AMD. People with intermediate AMD have either many medium-sized drusen or one or more large drusen. Some  people see a blurred spot in the center of their vision. More light may  be needed for reading and other tasks.
  3. Advanced Dry AMD. In addition to drusen, people with advanced dry AMD have a breakdown of light-sensitive cells and supporting tissue in the  central retinal area. This breakdown can cause a blurred spot in the  center of your vision. Over time, the blurred spot may get bigger and  darker, taking more of your central vision. You may have difficulty  reading or recognizing faces until they are very close to you. 

If you have vision loss from dry AMD in one eye only, you may not notice any changes in your overall vision.  With the other eye seeing clearly, you still can drive, read, and see  fine details. You may notice changes in your vision only if AMD affects  both eyes. If blurriness occurs in your vision, see an eye care  professional for a comprehensive dilated eye exam.



Normal vision  

The same scene as viewed by a person with age-related macular degeneration   


 Do drusen cause vision loss in advanced dry AMD?  

Drusen alone do not usually cause  vision loss. In fact, scientists are unclear about the connection  between drusen and AMD. They do know that an increase in the size or number of drusen raises a person's risk of developing either advanced dry AMD or wet AMD. These changes can cause serious vision loss.

The dry form has early and intermediate stages. Does the wet form have similar stages?  

No. The wet form is considered advanced AMD.

Can advanced AMD be either the dry form or the wet form?  

Yes. Both the wet form and the advanced dry form are considered advanced AMD. Vision loss occurs with either form. In most cases, only advanced AMD can cause vision loss.

People who have advanced AMD in one eye are at especially high risk of developing advanced AMD in the other eye.

Which is more common--the dry form or the wet form?  

The dry form is much more common. More than 85 percent of all people with intermediate and advanced AMD combined have the dry form.

However, if only advanced AMD is considered, about two-thirds of patients have the wet form. Because almost all vision loss comes from advanced AMD, the wet form leads to significantly more vision loss than the dry form.

Can the dry form turn into the wet form?  

Yes. All people who have the wet form had the dry form first.

The dry form can advance and cause vision loss without turning into the wet form. The dry form also can suddenly turn into the wet form, even during early stage AMD. There is no way to tell if or when the dry form will turn into the wet form.

Who is at risk for AMD?  

AMD can occur during middle age. The risk increases with aging. Other risk factors include:

  • Smoking.  
  • Obesity.  Research studies suggest a link between obesity and the progression of  early and intermediate stage AMD to advanced AMD.  
  • Race. Whites are much more likely to lose vision from AMD than African Americans.  
  • Family history. People with a family history of AMD are at higher risk of getting the disease.  
  • Gender. Women appear to be at greater risk than men. 

How is AMD detected?  

AMD is detected during a comprehensive eye exam that includes:

  • Visual acuity test. This eye chart test measures how well you see at various distances.
  • Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye  care professional uses a special magnifying lens to examine your retina  and optic nerve for signs of AMD and other eye problems. After the  exam, your close-up vision may remain blurred for several hours.
  • Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test. 

Your eye care professional also may do other tests to learn more about the structure and health of your eye.

During an eye exam, you may be asked to look at an Amsler grid.  The pattern of the grid resembles a checkerboard. You will cover one  eye and stare at a black dot in the center of the grid. While staring at  the dot, you may notice that the straight lines in the pattern appear  wavy. You may notice that some of the lines are missing. These may be  signs of AMD. (See Amsler grid.)

If your eye care professional believes you need treatment for wet AMD, he or she may suggest a fluorescein angiogram.  In this test, a special dye is injected into your arm. Pictures are  taken as the dye passes through the blood vessels in your retina. The  test allows your eye care professional to identify any leaking blood  vessels and recommend treatment.

How is dry AMD treated?  

Once dry AMD reaches the advanced stage, no form of treatment can prevent vision loss. However, treatment can delay and possibly prevent intermediate AMD from progressing to the advanced stage, in which vision loss occurs.  The National Eye Institute's Age-Related Eye Disease Study (AREDS) found  that taking a specific high-dose formulation of antioxidants and zinc  significantly reduces the risk of advanced AMD and its associated  vision loss. Slowing AMD's progression from the intermediate stage to  the advanced stage will save the vision of many people.

What is the dosage of the AREDS formulation?  

The specific daily amounts of  antioxidants and zinc used by the study researchers were 500 milligrams  of vitamin C, 400 International Units of vitamin E, 15 milligrams of  beta-carotene (often labeled as equivalent to 25,000 International Units  of vitamin A), 80 milligrams of zinc as zinc oxide, and two milligrams  of copper as cupric oxide. Copper was added to the AREDS formulation  containing zinc to prevent copper deficiency anemia, a condition  associated with high levels of zinc intake.

Who should take the AREDS formulation?  

People who are at high risk for developing advanced AMD should consider taking the formulation. You are at high risk for developing advanced AMD if you have either:

1. Intermediate AMD in one or both eyes.


2. Advanced AMD (dry or wet) in one eye but not the other eye.

Your eye care professional can tell you if you have AMD, its stage, and your risk for developing the advanced form.

The AREDS formulation is not a cure for  AMD. It will not restore vision already lost from the disease. However,  it may delay the onset of advanced AMD. It may help people who are at  high risk for developing advanced AMD keep their vision.

Can people with early stage  AMD take the AREDS formulation to help prevent the disease from  progressing to the intermediate stage?  

There is no apparent need for those diagnosed with early stage AMD to take the AREDS formulation. The study did not find that the formulation provided a benefit to those with early stage AMD. If you have early stage AMD, a comprehensive dilated eye exam every year can help determine if the disease is progressing. If early stage AMD progresses to the intermediate stage, discuss taking the formulation with your doctor.

Can diet alone provide the same high levels of antioxidants and zinc as the AREDS formulation?  

No. The high levels of vitamins and  minerals are difficult to achieve from diet alone. However, previous  studies have suggested that people who have diets rich in green leafy  vegetables have a lower risk of developing AMD.

Can a daily multivitamin alone provide the same high levels of antioxidants and zinc as the AREDS formulation?  

No. The formulation's levels of antioxidants and zinc are considerably higher than the amounts in any daily multivitamin.

If you are already taking daily  multivitamins and your doctor suggests you take the high-dose AREDS  formulation, be sure to review all your vitamin supplements with your  doctor before you begin. Because multivitamins contain many important  vitamins not found in the AREDS formulation, you may want to take a  multivitamin along with the AREDS formulation. For example, people with  osteoporosis need to be particularly concerned about taking vitamin D,  which is not in the AREDS formulation.

How is wet AMD treated?  

There are two main treatments for wet AMD: laser surgery and VEGF injections. Neither treatment is a cure for wet AMD.  Each treatment may slow the rate of vision decline or stop further  vision loss. The disease and loss of vision may progress despite  treatment.

  • Laser surgery. This procedure uses a laser to destroy the fragile, leaky blood  vessels. A high energy beam of light is aimed directly onto the new  blood vessels and destroys them, preventing further loss of vision.  However, laser treatment also may destroy some surrounding healthy  tissue and some vision. Only a small percentage of people with wet AMD can be treated with laser surgery. Laser surgery is more effective if the leaky blood vessels have developed away from the fovea, the central part of the macula. (See illustration at the beginning of this document.) Laser surgery is performed in a doctor's office or eye clinic.
    The risk of new blood vessels  developing after laser treatment is high. Repeated treatments may be  necessary. In some cases, vision loss may progress despite repeated  treatments.
  • VEGF injections.  Vascular endothelial growth factors inhibitors, like Lucentis and Avastin  are injected into the eye once every 4 wks for about a year to reduce or reverse bleeding and leakage.

What can I do if I already have lost some vision from AMD?    If you have lost some  sight from AMD, don't be afraid to use your eyes for reading, watching  TV, and other routine activities. Normal use of your eyes will not cause  further damage to your vision. 

If you have lost some sight from AMD,  ask your eye care professional about low vision services and devices  that may help you make the most of your remaining vision. Ask for a  referral to a specialist in low vision. Many community organizations and  agencies offer information about low vision counseling, training, and  other special services for people with visual impairments. A nearby  school of medicine or optometry may provide low vision services.

What research is being done?  

The National Eye Institute is conducting and supporting a number of studies to learn more about AMD.

For example, scientists are:

  • Studying the possibility of transplanting healthy cells into a diseased retina.  
  • Evaluating families with a history of AMD to understand genetic and hereditary factors that may cause the disease.  
  • Looking at certain anti-inflammatory treatments for the wet form of AMD. 

This research should provide better ways to detect, treat, and prevent vision loss in people with AMD.

What can I do to protect my vision?  

  • Dry AMD. If you have dry AMD,  you should have a comprehensive dilated eye exam at least once a year.  Your eye care professional can monitor your condition and check for  other eye diseases. Also, if you have intermediate AMD in one or both eyes, or advanced AMD in one eye only, your doctor may suggest that you take the AREDS  formulation containing the high levels of antioxidants and zinc.
    Because dry AMD can turn into wet AMD at any time, you should get an Amsler grid from your eye care  professional. Use the grid every day to evaluate your vision for signs  of wet AMD. This quick test works best for people who still have  good central vision. Check each eye separately. Cover one eye and look  at the grid. Then cover your other eye and look at the grid. If you  detect any changes in the appearance of this grid or in your everyday  vision while reading the newspaper or watching television, get a  comprehensive dilated eye exam.
  • Wet AMD. If you have wet AMD and your doctor advises treatment, do not wait. After laser surgery or  VEGF therapy, you will need frequent eye exams to detect any  recurrence of leaking blood vessels. Studies show that people who smoke  have a greater risk of recurrence than those who don't. In addition,  check your vision at home with the Amsler grid daily, one eye at a time.

If you detect any changes, schedule an eye exam immediately.


Here is what an Amsler grid normally looks like.  

This is how an Amsler grid might look like if abnormal.  Contact your EYEMD immediately if anything is different than what you see normally.

Can my lifestyle make a difference?  

Your lifestyle can play a role in reducing your risk of developing AMD.

  • Eat a healthy diet high in green leafy vegetables and fish.  
  • Don't smoke.  
  • Maintain normal blood pressure.  
  • Watch your weight.  
  • Exercise. 

What should I ask my eye care professional?  

You can protect yourself against vision  loss by working in partnership with your eye care professional. Ask  questions and get the information you need to take care of yourself.

What are some questions to ask?  

About my eye disease or disorder...

  • What is my diagnosis?  
  • What caused my condition?  
  • Can my condition be treated?  
  • How will this condition affect my vision now and in the future?  
  • Should I watch for any particular symptoms and notify you if they occur?  
  • Should I make any lifestyle changes? 

About my treatment...

  • What is the treatment for my condition?  
  • When will the treatment start and how long will it last?  
  • What are the benefits of this treatment and how successful is it?  
  • What are the risks and side effects associated with this treatment?  
  • Are there foods, drugs, or activities I should avoid while I'm on this treatment?  
  • If my treatment includes taking medicine, what should I do if I miss a dose?  
  • Are other treatments available? 

About my tests...

  • What kinds of tests will I have?  
  • What can I expect to find out from these tests?  
  • When will I know the results?  
  • Do I have to do anything special to prepare for any of the tests?  
  • Do these tests have any side effects or risks?  
  • Will I need more tests later? 

Other suggestions

  • If you don't understand your eye care professional's responses, ask questions until you do understand.  
  • Take notes  or get a friend or family member to take notes for you. Or, bring a tape  recorder to help you remember the discussion.  
  • Ask your eye care professional to write down his or her instructions to you.  
  • Ask your eye care professional for printed material about your condition.  
  • If you still have trouble understanding your eye care professional's answers, ask where you can go for more information.  
  • Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them, too. 

Today, patients take an active role in their health care. Be an active patient about your eye care.

Where can I get more information?


For more information about age-related macular degeneration, you may wish to contact:

AMD Alliance International
1929 Bayview Avenue
Toronto, Ontario
(416) 480-7505

American Health Assistance Foundation*
22512 Gateway Center Drive
Clarksburg, MD 20871
(301) 948-3244

Macular Degeneration Partnership
8733 Beverly Boulevard, Suite 201
Los Angeles, CA 90048
(310) 423-6455

Association for Macular Diseases
210 E. 64th Street
New York, NY 10021
(212) 605-3719

National Eye Institute (NEI)
31 Center Drive MSC 2510
Bethesda, MD 20892-2510
(301) 496-5248

For more information about low vision services and programs, you may wish to contact:

American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
(415) 561-8500

American Foundation for the Blind
11 Penn Plaza, Suite 300
New York, NY 10011-2006

Council of Citizens with Low Vision International

Lighthouse International
111 East 59th Street
New York, NY 10022-1202
(212) 821-9200
(212) 821-9713 (TDD)

National Association for Visually Handicapped
22 W. 21st Street, 6th Floor
New York, NY 10010-6493
(212) 889-3141