Age-Related Macular Degeneration (AMD)

Medically Reviewed by Poonam Sachdev on September 11, 2024
Written by Rachel Reiff Ellis, Shawna Seed
15 min read

Age-related macular degeneration (AMD) is an eye disease that may get worse over time. It’s the leading cause of serious, permanent vision loss in people older than 50. About 1 in 10 people in the U.S. are affected by the condition.

AMD happens when the central portion of your retina, called the macula, wears down. The retina is the light-sensing nerve tissue at the back of your eye.

Because the disease happens as you get older, it’s often called age-related macular degeneration. It usually doesn’t cause blindness but might cause serious vision problems.

Another form of macular degeneration, called Stargardt disease or juvenile macular degeneration, affects children and young adults.

 

You might not have any early signs of macular degeneration. In the early stages, your doctor would be able to see changes to your macula during an exam, but you may not have vision changes. Often, people don’t see an eye doctor until they’re in later stages and their vision is affected. 

What vision looks like with macular degeneration

Symptoms of macular degeneration may include:

  • Worse or less clear vision. Your vision might be blurry, and it may be hard to read fine print, drive, or recognize faces.
  • Dark, blurry areas in the center of your vision
  • Straight lines look wavy
  • Worse or different color perception
  • Trouble seeing in low light
  • Changes in how you see colors
  • Blank spots in your vision

If you have any of these symptoms, see an eye doctor as soon as possible.

There are two types of macular degeneration: wet and dry. Most people with macular degeneration have the dry form, but in its advanced stages, dry AMD can lead to the wet form of the disease.

Wet vs. dry macular degeneration

Wet and dry AMD have distinct differences.

Dry AMD. About 80% of people with age-related macular degeneration have dry AMD. This type causes yellow protein deposits, called drusen, in your macula. A few small drusen may not cause changes in your vision. But as they get bigger and you get more, they might dim or distort your vision, especially when you read. 

Dry AMD happens slowly. Your vision typically gets worse over the course of several years. As it gets worse, the light-sensitive cells in your macula get thinner and eventually die. In the atrophic form, you may have blind spots in the center of your vision. If that gets worse, you might lose central vision.

Wet AMD. This is a less common type of late-stage age-related macular degeneration. It tends to cause faster vision loss. Unstable blood vessels grow in your macula. These blood vessels leak blood and fluid into your retina, distorting your vision. You also may have blind spots and loss of central vision. These blood vessels and their bleeding eventually may form a scar, leading to permanent loss of central vision.

If you have macular degeneration, you’ll need to see your eye doctor regularly and let them know if you notice changes in your vision.

There are three stages of dry AMD:

  • Early. In this stage, you have no symptoms.
  • Intermediate. Some people have no symptoms at this stage. Or you might notice minor symptoms like central vision blurriness or trouble seeing things in dim light.
  • Late. In this stage, you probably will start to see straight lines as wavy. You also may have blurring in the center of your vision that can expand or get worse over time. Colors may look less bright, and it's even harder to see in low light. 

Wet AMD is always considered late stage. But dry AMD may turn into the wet form during any stage. 

Experts aren't sure why some people develop AMD and others don't. They believe that your genes and your environment may play a role.

People who get wet AMD always have dry AMD first. But those with dry AMD don't always go on to develop the wet type.

AMD risk factors

Risk factors for both types of age-related macular degeneration include:

  • Smoking
  • High blood pressure or high cholesterol 
  • Eating lots of saturated fat
  • Obesity
  • Being a woman or assigned female at birth
  • Having light skin

AMD epidemiology

AMD is the leading cause of permanent blindness in the industrialized world (more than 170 million people affected globally) and the third cause worldwide. Some other AMD facts and figures:

  • Among different racial groups, non-Hispanic White European people are at the highest risk of getting AMD, followed by Hispanic, Black, and Asian people.
  • People older than 75 are nearly 15 times more likely to get AMD than those 50-59 years old.

Women are slightly more likely than men to get AMD. But this may be simply because they tend to live longer.

Genetics and age-related macular degeneration

AMD researchers are looking at several genes, but two sets in particular stand out: the complement cascade group on chromosome 1 and the ARMS2/HTRA genes on chromosome 10.

If your genes on chromosome 1 and 10 -- or both -- have these variations, that doesn't mean you'll get AMD. But your risk goes up, and if you get AMD, it's more likely to progress to an advanced case.

The complement cascade plays an important role in your immune system, protecting your body against bacteria and viruses. Experts believe that this group of genes may misfire and attack healthy cells in your retina. Some scientists have long believed that the immune system plays a part in AMD, and the research on the complement cascade genes is evidence of that theory. 

Scientists also have found a strong connection between variations in the ARMS2/HTRA genes and age-related macular degeneration. But they don't know yet what those genes do or how they influence AMD. 

Certain genes also provide protection against AMD. Those include different variations in the complement cascade group and other genes that control how your body processes fat. 

Researchers continue to look into these genes, how they work, and how they affect AMD. At this point, experts don't believe genetic testing for AMD is useful.

Your doctor can check you for age-related macular degeneration when you see them for a routine eye exam and have your eyes dilated.

Tests for AMD

These tests can help your doctor diagnose the condition:

  • Retinal exam. During your eye exam, the doctor will examine your retina after dilating your pupil with drugs. 
  • Amsler grid. Your doctor also might ask you to look at an Amsler grid, a pattern of straight lines that's like a checkerboard. If some of the lines appear wavy or are missing, that could be a sign of macular degeneration.
  • Angiography. If your doctor finds AMD, you might have a procedure called angiography or one called optical coherence tomography (OCT). In angiography, your doctor injects dye into a vein in your arm. They take photographs as the dye flows through blood vessels in your retina. If there are new vessels, or if vessels are leaking fluid or blood in your macula, the photos will show their location and type. OCT is an imaging scan that can show fluid or blood underneath your retina without dye.

It’s important to see your eye doctor regularly to find signs of macular degeneration early. Treatment can slow the condition or make it less serious.

Some other eye conditions have symptoms that are like those of AMD, including:

  • Macular hole. This is a small hole that forms in the macula, leading to distorted vision.
  • Myopic macular degeneration. This affects only those with serious myopia (nearsightedness).
  • Stargardt disease. This is also known as juvenile macular degeneration. It's a hereditary condition that affects young people.
  • Diabetic retinopathy. This is a complication of diabetes that causes damage to blood vessels in the retina.

Treatment may slow the condition down and help preserve your vision. But there’s no cure for macular degeneration. 

Macular degeneration vitamins

Taking certain supplements and vitamins for AMD may protect your vision. 

A large study by the National Eye Institute, called AREDS (Age-Related Eye Disease Study), found that a certain combination of vitamins and nutrients may protect the eyes of some people with intermediate or late-stage AMD. The supplements may slow intermediate AMD's progression and might help some people keep their sight longer, too. Researchers later tweaked the formula, giving it the name AREDS2.

If you have a lot of drusen in your eyes, your doctor might recommend you take AREDS2 supplements. If you’ve lost vision in one eye, the supplements also might lower your chances of getting wet AMD and vision loss in your other eye.

AREDS2 supplements are sold over the counter. They're a combination of:

  • Vitamin C (ascorbic acid) 
  • Vitamin E, lutein, zeaxanthin, and zinc (as zinc oxide) 
  • Copper (as cupric oxide) 

These supplements don’t help everyone with dry AMD, though. Ask your eye doctor if they might be right for you. If your doctor gives you the green light, ask them to recommend a brand. Also ask your doctor to explain all the possible benefits and risks before you start taking the supplements. They may be part of some people’s treatment for wet AMD, too.

These supplements don't work to prevent AMD, so there's no need to take them if you don't have the condition.

AMD medication

If you have wet AMD, your treatments might include:

Anti-angiogenesis drugs. These medications block the creation of blood vessels and leaking from the vessels in your eye that cause wet AMD. You usually get them as injections into your eye. 

The main protein causing that growth is vascular endothelial growth factor (VEGF). VEGF inhibitors include: aflibercept (Eylea), bevacizumab (Avastin), pegaptanib (Macugen), and ranibizumab (Lucentis). 

Blocking angiopoietin-2 (Ang-2), another protein involved in forming blood vessels, helps stabilize fragile new vessels so they don't leak. It also makes vessels less sensitive to the effects of VEGF.

VEGF/Ang-2 inhibitors include: 

  • Faricimab-svoa (Vabysmo)

Many people who’ve taken these drugs got back some vision that was lost. You might need to have these treatments multiple times.

There is also a new type of drug for macular degeneration. If you have dry AMD, there are two new FDA-approved drugs that target your immune system and stop it from attacking the retina:

  • Avacincaptad pegol (Izervay)
  • Pegcetacoplan (Syfovre)

A doctor injects these drugs into your eye. Studies show they can slow the development of advanced dry AMD, but they don’t improve vision you’ve already lost.

Procedures for AMD

Several options are available for AMD:

Laser therapy. High-energy laser light can destroy abnormal blood vessels growing in your eye.

Photodynamic laser therapy. Your doctor injects a light-sensitive drug – verteporfin (Visudyne) – into your bloodstream, and it’s absorbed by the abnormal blood vessels. Your doctor then shines a laser into your eye to trigger the medication to damage those blood vessels.

Researchers also are studying experimental treatments for age-related macular degeneration. They include:

  • Submacular surgery. This procedure removes abnormal blood vessels or blood.
  • Retinal translocation. This destroys abnormal blood vessels under the center of your macula, where your doctor can’t use a laser beam safely. In this procedure, your doctor moves the center of your macula away from the abnormal blood vessels to a healthy area of your retina. This keeps you from getting scar tissue and more damage to your retina. Then, your doctor uses a laser to treat the abnormal blood vessels.

Alternative options for AMD

There's no scientific proof that any type of alternative treatments work for AMD, and they can't replace medical treatments. But some people use supplements or alternative therapies along with standard treatments. Always ask your doctor before you try an alternative treatment because some could interact with your medications or cause side effects.

Herbs. Among the herbs that may have some benefits to eye health are:

  • Ginkgo. This herb contains flavonoids, a substance known to promote eye health. A couple of studies found that people who took ginkgo were able to slow down vision loss.
  • Milk thistle. This plant contains a substance called silymarin that's good for your liver. Because your liver stores certain vitamins, it plays a role in eye health.
  • Bilberry and grape seeds. These are also high in flavonoids.

Alternative therapies. While there's no real evidence to show these practices are effective, some people try them for AMD symptoms:

  • Acupuncture. This treatment involves placing tiny needles into specific points of your body. Some people who practice acupuncture think it helps with AMD by increasing blood flow to the eyes. 
  • Microcurrent stimulation. This involves applying a slight electric current in the area around your eyes. The idea is that it could help cells in the retina get rid of waste products.

You also can talk to your doctor about low-vision aids, such as macular degeneration glasses with high powered lenses or other devices that help you see small print and do daily activities that require sharper vision.

Although White people of European descent appear more likely to get AMD than other groups, anyone can get it. Research has found differences in how people of color are diagnosed with and treated for the condition.

Studies have shown that Black people with AMD were 23% less likely than White AMD patients to be treated with anti-VEGF shots, the main treatment for dry AMD. Latino and Asian-American people are also less likely to be given this treatment.

Studies also show that Black people are 18% less likely than their White counterparts to get regular eye exams, which are important for detecting AMD.

Other research shows that people of color are underrepresented in clinical studies of new treatments for eye diseases. The rate at which Black people take part has been decreasing over the past 20 years, even as more Latino and Asian people take part.

The reasons for these disparities aren't clear but may involve a number of things, including access to health care, cultural mistrust of the health care system, and bias.

Age-related macular degeneration doesn't cause total blindness, even though it can affect central vision and cause permanent damage to your eye. Your vision loss might make it hard to: 

  • Drive 
  • Read
  • Recognize faces 
  • Do household tasks like cooking or yard work.

AMD treatment also can cause related problems with your eyes. These include: 

  • Eye infections
  • Detached retina
  • Damage to your eye's structure
  • Quicker onset of cataracts

Serious AMD can cause you to become legally blind. 

When you have AMD, you may need to seek help or change the way you do some of your everyday activities. But with the right support, you should be able to remain independent and maintain a good quality of life. 

AMD and diet

When you're diagnosed with AMD, your doctor may tell you to eat a balanced diet that’s rich in antioxidants and includes eye-friendly foods such as:

  • Fish high in omega-3 fatty acids such as salmon, anchovies, mackerel, and trout (aim for two to three times weekly)
  • Nuts, which are rich in vitamin E, selenium, and zinc (about a handful weekly)
  • Dark leafy greens like kale and spinach (daily)
  • Yellow/orange veggies like peppers and carrots (daily)
  • Antioxidant-rich fruits like berries (daily)

AMD costs

AMD can bring extra costs in several areas, including:

  • Doctor visits, treatments, and vision therapy
  • Low-vision aids and technology
  • Home modifications
  • Pay for caregivers
  • Lost productivity at work

AMD treatments can be expensive, though how much you pay out-of-pocket depends on your insurance. Without insurance, a 2-year course of treatment could cost between $9,000 and $65,000 per year, depending on what your doctor prescribes. Some drug companies and other groups offer programs to help low-income people with the costs. 

Macular degeneration self-care

Some things that can help you adapt to the vision limits that may come with AMD include:

Low-vision aids. These include devices that have special lenses or electronic systems to create larger images of nearby things. They help people who have vision loss from dry or wet macular degeneration make the most of their remaining vision. Your doctor also might prescribe glasses or contacts to help you see better.

Better lighting. Bright, consistent lighting throughout your environment helps with things like reading and cooking and also helps prevent falls.

Vision rehabilitation. A low-vision specialist can help you learn to make the most of your side (peripheral) vision and rely more on your other senses. They can help you learn to use low-vision devices and provide advice tailored to your specific needs.

Mental health and AMD

Any illness can be distressing, especially one that could cause major changes in your everyday life. If your AMD causes you to lose central vision, you're at a higher risk of becoming depressed or socially isolated.

Your doctor can recommend a therapist, counselor, or social worker or help you find a support group. Family and friends can also provide emotional support and help you take care of everyday tasks.

Macular degeneration usually gets worse over time. But not everyone who has AMD gets it in both eyes or progresses to the late stages.

The dry form of age-related macular degeneration tends to progress slowly over a period of years. The wet type, though, can come on suddenly.

Since early treatment can help keep symptoms from getting worse, it's important to have regular doctor appointments and eye exams. Wet macular degeneration probably will need repeated treatments. If you don't get follow-up treatments often enough, your vision may get worse than before you started treatment. 

What to expect with AMD

Most people with AMD will maintain good eyesight. Even those who lose central vision usually keep their side vision. Talk to your doctor about how your condition might progress. 

If you get advanced AMD, you might not be able to do things that require sharp eyesight, like driving or reading.

If you don’t have AMD, you can practice some healthy habits that may help you lower your chances of getting it. These tips promote age-related macular degeneration prevention: 

  • If you smoke, consider quitting.
  • Take charge of any other health conditions you have, like high blood pressure.
  • Stay at a healthy weight and get regular exercise.
  • Eat a balanced diet full of fruits, vegetables, and foods with omega-3 fatty acids (found in certain fish and nuts).

Having age-related macular degeneration doesn't mean you'll lose your sight. Timely treatment and healthy lifestyle changes can help protect your central vision. Even if you do lose some vision, steps like low-vision aids and therapy can help you stay independent and keep doing the things you enjoy.

What’s the best way to deal with AMD?

Early AMD doesn’t have a treatment, so it’s important to see your doctor regularly to watch for changes. You can help your vision by eating a healthy diet, exercising, and not smoking. If your AMD is in the intermediate stage, your doctor might recommend dietary supplements to help prevent it from becoming late-stage AMD. Later stages require treatment. Wet AMD treatment includes medicines called anti-VEGF drugs the doctor injects in your eye or photodynamic therapy (PDT), a combination of injections and laser treatment. The FDA has approved two new drugs to treat late-stage dry AMD that target your immune system. These treatments slow the disease but can’t bring back your lost vision.

What is the main cause of AMD?

Although experts don’t know exactly what causes AMD, they think your genes and your environment are factors. Some things can raise your risk. They include obesity, smoking, high cholesterol, eating lots of saturated fat, being a woman or assigned female at birth, and having light skin.

Can I live a normal life with macular degeneration?

You can live an active life with AMD with help from low-vision aids and attention to the sight you have through the help of visual rehabilitation. Doctors recommend focusing on your other senses as well as your peripheral (side) vision to improve your experience with the world.

How does someone with AMD see?

When you have AMD, your vision is typically blurry or fuzzy. You may have a hard time recognizing familiar faces, and straight lines may appear to be wavy. Most notably, you’ll have a dark, empty area or blind spot in the center of your vision.

How many years does it take to go blind with AMD?

The time it takes to lose your vision, and whether you lose it, depends on the type of AMD you have. Dry AMD progresses very slowly, over years. With proper treatment, you may never lose your vision. Wet AMD happens more quickly, but treatment can slow your vision loss.

What foods should you avoid with AMD?

Foods that are unhealthy in general also aren’t healthy for AMD. Avoid ultra-processed foods. They raise your risk of obesity and high cholesterol, both of which increase your chances of AMD. 

Is there a difference between macular degeneration and age-related macular degeneration?

These two terms refer to the same condition.

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