Macular Degeneration: Symptoms, Types, and When to See an Eye Doctor

Age-related macular degeneration (AMD) is an eye disease that damages the macula, the small part of the retina that gives you sharp, straight-ahead vision. The National Eye Institute (NEI) calls it a leading cause of vision loss in older adults and estimates that about 11 million people in the US have it [1]. AMD affects central vision, not side vision, and it does not cause complete blindness [1][4]. It can still make reading, recognising faces, driving and close work much harder.

This article covers the two types and their stages, early and later symptoms, risk factors, how eye doctors diagnose AMD, treatment options at a high level, who supplements are meant for, and when to get help. Urgency advice differs between the US and the UK, so each source is named.

Dry and Wet AMD

Dry (atrophic) AMD is the most common form. The American Academy of Ophthalmology (AAO) says about 8 in 10 people with AMD have the dry type [2]. The macula thins with age and tiny yellow deposits called drusen build up under the retina. The late stage of dry AMD is called geographic atrophy [2][8].

NEI describes three stages of dry AMD: early, intermediate and late. It usually progresses slowly over several years [1]. Dry AMD at any stage can turn into wet AMD, and wet AMD is always a late stage [1].

Wet (neovascular) AMD is less common but more serious. Abnormal blood vessels grow under the retina, where they can leak blood or fluid and scar the macula, so vision is lost faster than with the dry form [1][2][8]. The NHS notes that vision may worsen gradually over years and then quickly over weeks or months [4]. NEI adds that having late AMD in one eye raises the risk for the other eye [1].

Symptoms

Early dry AMD usually has no symptoms. Intermediate AMD may cause none, or mild central blurring and trouble seeing in low light [1]. This is why the AAO notes that many people do not realise they have AMD until their vision is quite blurry, and that regular eye exams can find early signs [2]. The NHS says AMD is sometimes picked up at a routine eye test before any symptoms appear [4].

As AMD advances, NEI and the NHS describe symptoms such as [1][5]:

• Straight lines that look wavy or crooked
• A blurry or distorted area near the centre of vision, which may grow
• Blank spots in central vision
• Colours that look less bright
• More difficulty seeing in low light
• Sensitivity to bright light, or flickering or flashing lights (NHS)

AMD is not painful and does not change how the eye looks [4]. Some people with sight loss see things that are not there. The NHS lists this as a symptom [5], and NICE guidance names Charles Bonnet syndrome as a topic clinicians should discuss with people who have AMD [6].

How AMD Changes Everyday Vision

Because AMD damages the centre of the retina, side vision usually keeps working. The AAO gives the example of looking at a clock: a person with AMD may still see the numbers around the edge but not the hands in the middle [2].

The NHS says AMD usually first affects people in their 50s [4].

Who Is at Higher Risk

The main risk factors named by NEI and the AAO are older age, a family history of AMD, smoking, and being White [1][2]. NEI says risk rises from age 55, and the AAO describes AMD as a leading cause of vision loss in people over 50 [1][2].

The AAO also lists a diet high in saturated fat, being overweight, high blood pressure, heart disease and high cholesterol [2]. NICE guidance for UK professionals adds AMD in the other eye, a BMI of 30 or more, lack of exercise, a diet high in fat, and a diet low in omega-3 and omega-6 fatty acids, vitamins, carotenoids and minerals [6]. The NHS says the exact cause is not known [4].

Smoking stands out because NEI, the AAO, the NHS and NICE all name it, and it can be changed. NEI says you may lower your risk or slow vision loss by not smoking, staying active, keeping blood pressure and cholesterol healthy, and eating leafy green vegetables and fish [1]. The AAO says a balanced diet with dark leafy greens, yellow fruit and vegetables, and fish has been shown to benefit people with AMD [2]. These steps may help, but they are not a cure.

How AMD Is Diagnosed

An eye doctor usually looks at the retina during a dilated eye exam and may use optical coherence tomography (OCT), a scan that shows the layers of the retina [1][2]. The AAO says fluorescein angiography, where dye is injected into an arm vein and photographs track it through the retinal blood vessels, can show abnormal vessels [2]. In the UK, NICE recommends OCT for suspected wet AMD and reserves angiography for cases where OCT does not rule out new vessels [6].

The AAO notes that eye doctors may also ask you to look at an Amsler grid during the exam to check for distorted or missing areas in your central vision [2]. Results from these tests help the eye doctor decide which type and stage of AMD you have, which matters because treatment options depend on the stage [1][2].

Treatment

There is no cure for AMD [7]. Treatment aims to slow damage and protect remaining vision.

Early AMD: NEI says there is no treatment yet, so eye doctors monitor it and encourage healthy habits [1].

Wet AMD: The main treatment is a group of medicines called anti-VEGF drugs, injected into the eye to stop abnormal vessels growing and leaking [1][2][7]. Some people may have photodynamic therapy or laser treatment of the abnormal vessels instead [1][2][7]. Your eye specialist decides the schedule.

Late dry AMD (geographic atrophy): The NHS says there is currently no treatment for dry AMD [7], and NEI also says there is no treatment for late dry AMD [1]. In the US, the AAO notes that injected medicines may slow the progression of geographic atrophy [2]. Whether these are offered depends on your country and your specialist.

Low vision support: Low vision aids, support services and vision rehabilitation can help people keep doing daily tasks [1][2][7]. Ask your eye doctor or optician what is available near you.

Supplements: Who They Are For

Eye vitamins are not for everyone with AMD. NEI says a specific supplement formula may stop intermediate AMD from becoming late AMD, and may slow late AMD in the other eye when only one eye is affected [1]. NEI does not recommend them as a treatment for early AMD [1].

A Cochrane review of 26 studies with evidence up to November 2022 found that this type of antioxidant vitamin and mineral supplement probably slows progression to late AMD in a review covering 11,952 people, with people who have intermediate AMD more likely to benefit than those with early AMD [8]. Taking lutein and zeaxanthin on their own had little or no effect on progression, and Cochrane notes that the safety evidence comes from smaller studies [8].

The AAO says the formula is meant for people with certain types of drusen, that not every form of AMD benefits, and that an ophthalmologist should decide whether it is right for you [2].

The AAO says the original formula included beta-carotene, which people who smoke should not take because of a raised lung cancer risk [2]. Cochrane reports that beta-carotene may raise lung cancer risk in people who have smoked [8]. Newer versions replace it with lutein and zeaxanthin [2][8]. Talk to your eye doctor before starting any eye supplement.

The Amsler Grid

The AAO describes the Amsler grid as a square grid of lines with a dot in the centre [3]. It advises people who have AMD to check each eye daily, one at a time and wearing reading glasses, to spot wavy lines or blank areas that may mean dry AMD is turning wet [3]. Report any new change to your eye doctor [3]. The grid is a home check for people already diagnosed. It does not replace an eye exam [2][3].

When to See an Eye Doctor

Advice on urgency comes from different health systems, so it is listed by country.

US (NEI): Straight lines that start to look wavy are a warning sign of late AMD, and NEI advises seeing your eye doctor right away [1]. People at higher risk should have regular dilated eye exams and ask their eye doctor how often [1].

UK (NHS): See an optician if you are worried about your vision. Get an urgent optician appointment or contact NHS 111 if your vision suddenly gets worse, if a dark curtain or shadow moves across your vision, or if your eye becomes red and painful, because these can signal other eye problems that need treatment straight away [5].

UK professional guidance (NICE): NICE recommends that people with suspected wet AMD be referred urgently to a specialist macula service, normally to be seen within 1 working day [6]. This is a service standard from 2018 guidance, not a promise about your appointment.

If you are unsure whether glaucoma, which usually affects side vision first, might also be a concern, see Glaucoma: Early Signs, Risk Factors, and When to Get Checked. For age-related changes in the lens rather than the macula, see Cataracts: Symptoms, Causes, and When to See an Eye Doctor. For gritty, burning eyes rather than central vision changes, see Dry Eye Disease: Symptoms, Causes, and When to See an Eye Doctor.

Conclusion

AMD does not cause complete blindness, but finding it early protects the vision you have. If you are over 50, smoke, or have family members with AMD, keep up regular eye exams, and act quickly on any new distortion in your central vision.

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you notice a sudden change in your vision, seek care promptly.