About 12.6% of Americans 65 and older show some sign of age-related macular degeneration, and roughly 1.5% have advanced disease that threatens central vision. Macular degeneration attacks the small, cone-rich center of the retina responsible for reading, driving, and recognizing faces — while leaving peripheral vision intact. That is why a person with advanced AMD can navigate a hallway but cannot read a menu or see a loved one’s expression.
Two recently approved drugs for geographic atrophy and an expanding pipeline of gene therapies have shifted the treatment landscape since 2023. This guide explains the difference between dry and wet AMD, how the disease is staged, the role of AREDS2 supplements, and what to expect from anti-VEGF injections. For a wider view of senior eye health, our medical conditions hub covers related disorders.
What Macular Degeneration Is
The macula is the central 5.5 millimeters of the retina, packed with cone photoreceptors that handle fine detail and color. In AMD, waste products called drusen accumulate beneath the retinal pigment epithelium (RPE). Over time, the RPE and overlying photoreceptors die in a slow process called geographic atrophy (GA), or — in about 10 to 15% of cases — abnormal blood vessels grow up from the choroid and leak fluid and blood, the hallmark of “wet” or neovascular AMD.
The American Academy of Ophthalmology stages AMD using the AREDS classification: early (medium drusen, no pigment changes), intermediate (large drusen or pigment abnormalities), and late (GA or neovascular AMD). Most people with AMD have the dry form. Late dry AMD with GA was untreatable until 2023.
Risk Factors
Age is the dominant risk factor — prevalence rises sharply after 75. Family history matters: complement factor H (CFH) and ARMS2 gene variants are well-established susceptibility loci. The National Eye Institute identifies smoking as the strongest modifiable risk factor, doubling to quadrupling risk depending on pack-years. White ancestry, hypertension, obesity, diet low in leafy greens, and unprotected UV exposure also contribute.
Stopping smoking at any age slows progression. Mediterranean-style diets rich in lutein, zeaxanthin, omega-3 fatty acids, and dark leafy greens have shown protective associations in the AREDS2 cohort and other longitudinal studies.
Symptoms by Stage
Early AMD is usually asymptomatic and detected only on dilated exam. Intermediate disease can produce mild blurring of central vision, slower dark adaptation when entering a dim room, and the sense that print “moves” or “fades.” Late dry AMD causes a slowly enlarging blind spot — patients describe missing letters in the middle of words or no longer recognizing faces unless they look slightly off-center.
Wet AMD often announces itself abruptly. Straight lines appear wavy or bent (a phenomenon called metamorphopsia), a dark or distorted spot grows over days to weeks, and color perception dims. The Amsler grid — a printed graph patients view at home — is designed to catch these changes early. Any new metamorphopsia warrants same-week ophthalmology evaluation, because anti-VEGF therapy is most effective before significant scarring occurs.
When to seek emergency care: Call 911 or go to the emergency room for sudden, painless loss of central or peripheral vision, a curtain across the field, flashes with new floaters, or severe eye pain with nausea. These point to retinal detachment, vitreous hemorrhage, or acute angle-closure glaucoma rather than typical AMD progression.
How AMD Is Diagnosed
A dilated fundus exam reveals drusen, pigment changes, GA, and signs of neovascularization. Optical coherence tomography (OCT) provides cross-sectional imaging of the retinal layers and is the workhorse for monitoring fluid in wet AMD. Fluorescein angiography or OCT angiography maps abnormal vessels when neovascularization is suspected. Fundus autofluorescence highlights areas of RPE loss and is used to track GA growth.
Genetic testing is not recommended for routine clinical care, per AAO guidelines, because results do not currently change management.
Treatment of Dry AMD
For intermediate dry AMD or late AMD in one eye with intermediate disease in the fellow eye, the AREDS2 formulation reduces five-year progression risk to advanced AMD by about 25%. The formula contains 500 mg vitamin C, 400 IU vitamin E, 80 mg zinc, 2 mg copper, 10 mg lutein, and 2 mg zeaxanthin. AREDS2 trial data showed beta-carotene increased lung cancer risk in smokers and was replaced with lutein/zeaxanthin. Smokers and former smokers should specifically use the AREDS2 formulation.
Until 2023, no treatment slowed geographic atrophy. The FDA approval of pegcetacoplan (Syfovre) in February 2023 and avacincaptad pegol (Izervay) in August 2023 — both intravitreal complement inhibitors — modestly slow GA expansion (around 14 to 36% reduction in lesion growth depending on dosing and trial arm). They do not restore lost vision and require monthly or every-other-month injections, with infrequent risks of new-onset wet AMD, vasculitis, and ischemic optic neuropathy. Whether and when to start these drugs is an evolving discussion with a retina specialist.
Treatment of Wet AMD
Anti-VEGF intravitreal injections transformed wet AMD prognosis. Aflibercept (Eylea, including the higher-dose Eylea HD approved 2023), ranibizumab (Lucentis and biosimilars), bevacizumab (Avastin, off-label but extensively used), brolucizumab (Beovu), and faricimab (Vabysmo) all suppress vascular endothelial growth factor and reduce leakage. Most patients receive monthly injections initially, then “treat-and-extend” intervals stretching to 8, 12, or 16 weeks.
About 90% of treated patients avoid significant vision loss at one year, and roughly 30 to 40% gain three or more lines of vision on the eye chart. Untreated wet AMD typically progresses to legal blindness in the affected eye within two years. Injections are uncomfortable but brief; serious complications like endophthalmitis occur in fewer than 1 in 2,000 injections.
Living With AMD: Low-Vision Resources
When vision loss limits daily function, low-vision rehabilitation can dramatically extend independence. Magnifiers, e-readers with adjustable contrast, eccentric viewing training, and screen-reader software are reimbursed under Medicare’s low-vision rehabilitation benefit when prescribed appropriately. Driving generally becomes unsafe with central acuity worse than 20/40 — a practical bridge to broader concerns covered in our driving safety guide for older adults.
Social engagement matters more than people expect. Untreated social isolation is associated with faster cognitive decline among adults with vision impairment, per NIA-funded research.
Frequently Asked Questions
Does macular degeneration cause total blindness?
AMD spares peripheral vision. Even with advanced disease, most people retain enough side vision to navigate familiar spaces. Legal blindness (acuity 20/200 or worse) is possible, but complete darkness is not a typical outcome of AMD alone.
Should I take AREDS2 vitamins if I only have early AMD?
The AREDS2 trial found benefit for intermediate AMD or advanced AMD in one eye, not for early AMD. Routine supplementation for early AMD is not currently recommended by the AAO. A retina specialist can stage your disease and tell you whether you fit the trial population.
Is wet AMD curable?
Anti-VEGF injections suppress neovascularization and preserve vision but do not cure the underlying degeneration. Most patients require ongoing injections for years. Stopping treatment usually allows recurrence within months.
Can lifestyle changes reverse macular degeneration?
No intervention reverses established drusen or atrophy. Smoking cessation, blood pressure control, Mediterranean diet, and AREDS2 supplements (when indicated) slow progression. The earlier these are adopted, the better the trajectory.
The Bottom Line
Macular degeneration is the leading cause of irreversible central vision loss in older Americans, but the prognosis today is meaningfully better than a decade ago. Dilated exams every year after 60 — and every 6 months once intermediate AMD is identified — catch wet conversion before it scars. AREDS2 supplements help selected patients, complement inhibitors offer a first-ever option for geographic atrophy, and anti-VEGF therapy preserves driving and reading vision in most patients with neovascular disease. Use an Amsler grid, do not smoke, and call your retina clinic the day distortion appears.