Age-related macular degeneration (AMD)

AMD can make your central vision blurry or distorted and can affect tasks such as reading, watching television or looking at photos. Over time, a dark or missing area may appear in the middle of your vision. AMD doesn't cause pain and doesn't lead to the total loss of sight.

This page contains a summary of our information on AMD. To read our full information, download our Understanding age-related macular degeneration booklet, which is accredited by the Royal College of Ophthalmologists:

Everyone can have slightly different symptoms, but usually the first thing you’ll notice is that it’s harder to see detail, such as small print. You may find that you have a small, blurred area in the centre of your vision. Straight lines may look distorted or wavy, or like there’s a little bump in them. You may also find that you’re more sensitive to bright light.

You should have your eyes examined by an optometrist (also known as an optician) if you experience any of these in one or both eyes:

• You have difficulty reading small print despite wearing reading glasses.
• Straight lines start to look wavy or distorted. You can check this by looking at door and window frames, or tiles in your home.
• Your vision isn’t as clear as it used to be.

These changes can happen gradually or more suddenly. If you notice changes to your vision quickly, you should see your optometrist straight away.

AMD can be described as ‘early’ or ‘late’.

Early AMD

In early AMD, you may have no symptoms, and your vision may still be good. It is often picked up in a routine eye examination by the optometrist. They may be able to see medium or large drusen at the macula when they examine the retina. Drusen are small lipid and protein deposits under the retina, which they can see as yellow dots. Unlike medium or large drusen, small drusen can happen as a normal part of ageing and are not always a sign that someone has AMD. Your optometrist might say you have early AMD if you have a few medium or large sized drusen in one or both your eyes. As AMD progresses, you may start to notice changes to your vision.

AMD is a progressive condition, which means it can worsen over time. This can happen in different stages. How it progresses can vary between different people, and not everyone will reach the later stages of AMD.

Late AMD 

There are two main types of late AMD:

• Dry AMD (also called geographic atrophy)
• Wet AMD (also called choroidal neovascularisation)

They are called ’dry’ and ‘wet’ because of what happens inside your eye, not because of how your eye feels or whether you have a watery or dry eye (which relate to tear production at front of your eye).

Dry AMD

Dry AMD is the more common type of AMD. It develops very slowly and causes a gradual change in your central vision. It happens because cells at the macula degenerate and stop working. It usually takes a long time – sometimes years, to get to its final stage. Late stage dry AMD causes a dark or missing area in the centre of your vision. This is known as late AMD or geographic atrophy (GA). Some people with this type of AMD may go on to develop the wet form of AMD.

Wet AMD

Wet AMD happens when the cells of the macula stop working correctly and your body starts growing new blood vessels to fix the problem. These blood vessels grow in the wrong place and cause swelling and bleeding underneath the macula – this is why it’s called wet AMD. It causes more damage to your macula and eventually leads to scarring. Both the new blood vessels and the scarring can damage your central vision.

Wet AMD can develop very quickly, causing serious changes to your central vision, within days or weeks.

Treatment is available for wet AMD which stops the new blood vessels from growing and damaging your macula. This treatment usually needs to be given quickly before the new blood vessels do too much damage to your macula. If the blood vessels are left to grow, the scarring and the sight loss they cause is usually permanent.

People who’ve had wet AMD for a long time that has caused scarring on their retina, may be told that their wet AMD has “dried up”. This usually means that there are no new blood vessels growing and that your macula has been badly scarred. At this stage of late AMD, the treatments available will no longer help.

Both types of late AMD 

Wet and dry AMD have a few things in common:

• They usually affect both your eyes, although sometimes one eye may be affected long before the other. If you have AMD in one eye only, the other eye may compensate so you may not notice the blurring of vision in the early stages.
• Both wet and dry AMD only affect your central vision and won’t affect your peripheral vision. This means that you should still be able to get around on your own and make use of this vision.
• Neither type of AMD will cause you to lose all your sight.

Some people diagnosed with dry AMD may find that, with time, new blood vessels grow, and they develop wet AMD. If you have dry AMD and you notice a sudden change in the sight of either of your eyes, you should let your optometrist know as soon as possible. This is because dry AMD can develop into wet AMD, and if this happens, sight saving treatment may be possible.

Some people may have wet AMD in one eye and dry AMD in the other which doesn’t develop into wet AMD. Most people, however, have the same type of AMD in both eyes.

If you have early or dry AMD, you’ll usually be monitored by your optometrist. It’s important to have regular appointments so they can monitor any changes to your AMD and to your sight.

Your optometrist will let you know how often they would like to see you for an appointment. They may wish to see you every year or two.

Between your appointments, you may be advised to monitor your vision at home regularly by closing one eye at a time and looking at window/ door frames or tiles to see if there is any distortion. Some optometrists may provide you with a paper‑based test called an Amsler grid along with instructions to help you monitor your vision at home.

If at any time between appointments, you feel like your vision has deteriorated, you should let your optometrist know straight away.

Your optometrist may refer you to an ophthalmologist (hospital eye doctor) if:

• They suspect you may have wet AMD. You’ll be referred quickly to an eye clinic. This may be to an NHS hospital eye clinic or an independent hospital or treatment centre in the community providing NHS care. Your optician will let you know where you are being referred. You should expect to be seen by the eye clinic within two weeks.
• You have dry AMD and your vision has worsened to a stage where you could be certified with sight loss. You will be referred routinely to the eye clinic.

At the eye clinic 

Your care at the eye clinic will be led by a consultant ophthalmologist. While you may not always meet the consultant at your visits, you will be looked after by different members of their clinical team.

If there are no signs of wet AMD, you will usually be discharged back to your optometrist (optician) for regular monitoring. It’s important to continue to attend regular eye tests with your optometrist and see them straight away if your vision changes in between appointments.

If tests confirm that you have wet AMD, your ophthalmologist will explain the treatment, including the benefits and risks. You can expect to start treatment within 2 weeks of when you were referred.

Early and dry AMD has no treatment.

There’s some evidence that taking a specific combination of antioxidant vitamins and minerals may help slow down the worsening of AMD in some people. The group of people most likely to benefit from taking a supplement are those who have a high risk of their AMD worsening. Your optometrist can give you advice on whether they are likely to help your AMD. 

Click the link below for more information on antioxidant vitamins for AMD:

Antioxidant vitamins for AMD

Treating wet AMD

The treatment available on the NHS for wet AMD is a group of medications called anti-vascular endothelial growth factors (anti-VEGFs) drugs. As new blood vessels grow in your eye, your body produces a chemical which encourages further new blood vessel growth. Anti-VEGF drugs interfere with this chemical and stop the vessels from growing. This reduces further damage to your sight.

Anti‑VEGF treatments usually have a high success rate. In most cases, they stop your sight from getting worse in the short term. In the long term, your vision may gradually worsen even with treatment, but this happens much more slowly than if you were not treated. Your eye clinic will explain:

• which type of anti‑VEGF medication you will receive
• how often you are likely to need it
• how your progress will be monitored
• what the procedure involves and discuss the possible risks, so you have the information you need to make an informed decision. If you choose to go ahead with treatment, you will be asked to sign a consent form.

If you need help deciding about anti VEGF treatment for wet AMD, the NHS provides a support decision tool.

Click the link below for more information on anti-vascular endothelial growth factor (anti-VEGF) drugs.

More information on anti-VEGF drugs.

How often will I need anti-VEGF treatment? 

Normally, a course of three injections, one a month for three months, is given to start with. This is known as a ‘loading dose’.

How often you need further injections will depend on:

• The type of anti‑VEGF drug you are receiving. There are different types of anti‑VEGFs. Some last longer, which means you have a longer gap between injections.
• How well the treatment is working. Your vision and macula will be monitored regularly with tests and scans to check how the macula is responding to treatment. If it is responding well, your injections can be spaced further apart.

It’s common for people to have more injections after the first three. Some people may need to have an injection once a month or every few months on a regular basis until the bleeding and swelling is under control and their sight is stable. Other people may go for several months without needing treatment, with injections spaced out across the year.

In some cases, you may be switched to a different anti VEGF drug if the first one has not worked well. If the wet AMD becomes inactive (meaning there is no longer any active bleeding), you may not need further injections, but you’ll continue to be monitored regularly. This might be at the eye clinic or at a clinic in the community. Monitoring is important because in some cases, wet AMD can come back and this needs to be picked up as early as possible.

Sometimes, treatment may also be stopped if your ophthalmologist believes that continuing treatment will not stabilise or help your vision.

Managing your appointments 

Ask your eye clinic about your treatment plan and when you need your next treatment or monitoring appointment. If your vision gets worse while waiting for your next treatment or monitoring appointment, contact your eye clinic straight away for advice. If you haven’t received your appointment when expected, contact your eye clinic booking team.

Treatment for wet AMD often means regular visits to the eye clinic. This can feel tiring and time‑consuming. These visits are important to protect your sight, but they can feel like a burden. If getting to the eye clinic is difficult, let your eye clinic team know. They may be able to offer advice or support. You can also arrange support from family or friends and keep a calendar to help you keep track of your appointment schedule.

I’m worried about having an injection into my eye, is there any support? 

The thought and experience of having an injection into the eye can be unpleasant. However, not having treatment can mean you will lose more of your central vision. If you’re worried or frightened of having injections into your eye, it may help to talk to someone who has already experienced the injections. The Macular Society can put you in touch with a ‘treatment buddy.’

With the right support, you can live confidently and independently with your condition. You may not need all this support right now, but you can access further support at any time you need it.

Driving 

Ask your optometrist or ophthalmologist about whether you can continue driving. This will depend on whether your sight meets the DVLA’s vision standards. You’re required by law to tell DVLA about your eye condition if it affects both eyes (or one eye, if you only have sight in one eye).

Charles Bonnet Syndrome (CBS) 

Some people who have lost a lot of vision because of AMD or another eye condition may experience visual hallucinations – they may see shapes, colours or figures that aren’t really there. This condition is known as Charles Bonnet Syndrome (CBS). CBS visual hallucinations are silent and do not involve any of the other senses. You cannot hear, smell, or touch the images and people are aware that what they are seeing isn’t real.

Making the most of your sight

Both types of AMD can have a big impact on your central vision. Unfortunately, changes in your central vision are permanent and can’t be fully corrected with new prescription glasses. However, most people with AMD have some vision and there are a lot of things you can do to make the most of your remaining vision. This may mean making things bigger, using brighter lighting, or using colour to make things easier to see.

Low vision assessment

A low vision assessment can help you make the most of your vision. Ask your eye clinic or optometrist about having a low vision assessment. During this assessment, a low vision practitioner can explore aids or techniques that can help you make the most of your vision. This might be with magnifying glasses or aids, or by helping you learn ways of using your vision, called vision strategies. Eccentric viewing is a vision strategy of reading using an area in your side vision when you have central vision loss.

It’s completely natural to be upset when you’ve been diagnosed with AMD and it’s normal to find yourself worrying about the future and how you will manage with a change in your vision.

It can sometimes be helpful to talk about these feelings with someone outside of your circle of friends or family. At RNIB, we can help with our Counselling and Wellbeing team. Your GP or social worker may also find a counsellor for you if you feel this might help.

The Macular Society also offer a counselling service.

Eye Care Liaison Officer (ECLO)

Your eye clinic may also have a sight loss adviser. This advisor may be known as either the Eye Care Liaison Officer (ECLO), the Vision Support Officer or the Early Intervention Support Officer and they are on hand to provide you with further practical and emotional support about your eye condition. To find out if your hospital eye clinic has an ECLO, you can call our Helpline.

Connecting with others and support for your eye condition

The Macular Society has local groups which meet throughout the country. Sometimes, it can help to talk about your feelings or share your experience with people who may have had similar experiences.

Finding out about research

If you would like to find out more about research into AMD, the following links may be helpful. You can also ask your eye specialist about any research that may be happening into your eye condition. It’s important to talk to your eye specialist first if you are considering taking part in any trial.

• Research Opportunities at Moorfields (ROAM)
• Eye Research Group Oxford (ERGO)
• Be Part of Research
• Macular Society
• European Clinical Trials Register

Watch our Living with AMD story