Age-related macular degeneration

Age-related macular degeneration (AMD) is a progressive eye condition affecting the macula and is one of the leading causes of vision loss in people over 50. Although AMD affects central vision, it does not lead to complete blindness; most people retain good peripheral vision and can adapt well with the right support. Understanding the early signs and seeking prompt specialist care can make a significant difference in preserving vision.

The retina is a thin layer of tissue lining the back of your eye. It converts light into electrical signals that are sent to your brain, allowing you to see. The macula is the most sensitive part of the retina and is essential for detailed, colour vision.

In AMD, the macula gradually deteriorates. The changes are linked to ageing, but the exact cause is a combination of genetic and lifestyle factors. There are two main types of AMD:

Dry macular degeneration

  • The most common form. Caused by the gradual thinning of the macula and the accumulation of tiny yellow deposits called drusen.
  • Progresses slowly over years.
  • Vision changes are often subtle at first, but you may notice blurriness or the need for brighter light.

Wet macular degeneration

  • Less common but more severe.
  • Caused by the growth of abnormal blood vessels under the retina.
  • These vessels can leak fluid or blood, leading to rapid vision loss.
  • Requires urgent treatment to prevent further damage.

What are the first signs of macular degeneration?

AMD can be tricky to detect early because it may cause no symptoms in the beginning. Regular eye exams are often the only way to catch it early.

When symptoms do appear, they might include:

  • Blurred or fuzzy vision in the centre of your sight
  • Needing more light to read or do close work
  • Colours appearing faded or less vibrant
  • Difficulty recognising faces, even when the rest of the image seems clear
  • Distortion in straight lines (a doorway frame may appear bent or wavy)
  • A dark, empty, or blurry spot in your central vision

It is useful to seek advice on the severity of your macular degeneration as the risk of progression to visual loss varies from 3% to 40% over 5 years depending on the appearance of the retina.

While the exact cause isn’t fully understood, research suggests AMD develops from a mix of age-related changes, genetic predisposition, and environmental factors. Known risk factors include:

  • Age: Risk increases significantly after 50
  • Family history: Having a close relative with AMD increases your risk
  • Smoking: One of the strongest modifiable risk factors, doubling the risk of AMD
  • Cardiovascular health: High blood pressure, high cholesterol, and heart disease are linked to AMD
  • Diet: Low intake of antioxidants (vitamins C, E, zinc, lutein, zeaxanthin) and omega-3 fatty acids
  • Obesity: Excess weight can accelerate disease progression
  • Prolonged UV exposure: May contribute to retinal damage over time

What vision looks like with AMD

Dry AMD:

  • Vision becomes blurry in the centre but remains relatively stable over time
  • You may notice more difficulty with reading or recognising faces, but peripheral vision is clear

Wet AMD:

  • Rapid onset of distortion and central vision loss
  • Straight edges (like window frames or text lines) appear bent
  • Dark or empty spots may appear in the centre

Dry AMD often develops slowly over many years. Some people maintain good vision for a long time. Wet AMD can progress quickly, sometimes causing significant vision loss in a few months without treatment.

Early detection is critical, as treatments are most effective when started promptly.

How is AMD diagnosed?

A retinal specialist can diagnose AMD through a comprehensive eye examination, which may include:

  • Visual acuity testing: Measures how well you see at various distances
  • Dilated eye exam: Allows a clear view of the retina and macula
  • Optical coherence tomography (OCT): Scans the retina to detect thinning, swelling, or fluid
  • Amsler grid: A simple test to detect distortion in vision
  • Fluorescein angiography: Dye-based imaging to highlight abnormal blood vessels in wet AMD

Dry AMD:

There is currently no cure for dry age-related macular degeneration, but its progression can often be slowed through healthy lifestyle changes and, in some cases, specific nutritional supplements such as the AREDS2 formula. Patients are also encouraged to monitor their vision regularly at home using an Amsler grid, which can help detect any new distortions or changes at an early stage.

Wet AMD:

Wet age-related macular degeneration is treated primarily with anti-VEGF injections, which are given directly into the eye to block the growth of abnormal blood vessels and reduce leakage. In certain cases, photodynamic therapy may also be recommended. Because wet AMD can change rapidly, regular follow-up appointments are essential to assess treatment response and adjust care as needed.

How to prevent or reduce the risk of AMD

While you can’t change your age or family history, you can lower your risk by:

  • Stopping smoking: The most effective preventive step
  • Eating a balanced diet rich in leafy greens, colourful vegetables, and oily fish
  • Controlling blood pressure and cholesterol
  • Maintaining a healthy weight
  • Wearing sunglasses that block UV rays
  • Having regular eye exams, especially after age 50

Get the answers and care you need

Tom Williamson retinal specialist london