Age-related macular degeneration (AMD) is a painless eye condition that generally leads to the gradual loss of central vision but can sometimes cause a rapid reduction in vision.
Central vision is used to see what is directly in front of you. In AMD, your central vision becomes increasingly blurred, leading to symptoms such as:
difficulty reading because the text appears blurry
colours appearing less vibrant
difficulty recognising people's faces
AMD usually affects both eyes, but the speed at which it progresses can vary from eye to eye.
AMD does not affect the peripheral vision (outer vision), which means it will not cause complete blindness.
When to seek medical advice
If you notice that your vision is getting gradually worse, you should see your GP or optometrist.
If your vision suddenly gets worse, images are distorted or you notice blind spots in your field of vision, seek medical advice immediately. Either book an emergency appointment with an optometrist or visit your local accident and emergency (A&E) department.
If it is thought you may have AMD, you will be referred to a specialist called an ophthalmologist for tests and any necessary treatment.
Why it happens
Macular degeneration develops when the macula (the part of the eye responsible for central vision) is unable to function as effectively as it used to. There are two main types of AMD, called 'dry AMD' and 'wet AMD'.
Dry AMD develops when the cells of the macula become damaged as a result of a build-up of waste products called drusen. It is the most common and least serious type of AMD, accounting for around nine out of 10 cases.
The loss of vision is gradual, occurring over many years. However, an estimated one in 10 people with dry AMD will then go on to develop wet AMD.
Wet AMD develops when abnormal blood vessels form underneath the macula and damage its cells (doctors sometimes refer to wet AMD as neovascular AMD).
Wet AMD is more serious and without treatment, vision can deteriorate within days.
Who is affected
AMD is the leading cause of visual impairment in the UK, affecting up to 500,000 people to some degree.
For reasons that are unclear, AMD tends to be more common in women than men. It is also more common in white people and people of Chinese ethnicity than people from other ethnic groups.
As would be expected by its name, age is one of the most important risk factors for AMD. The condition is most common in people over 50 and it's estimated that one in every 10 people over 65 have some degree of AMD.
How AMD is treated
There is currently no cure for either type of AMD.
With dry AMD, treatment is mostly based on helping a person make the most of their remaining vision, such as using magnifying lenses to help make reading easier.
There is also some evidence to suggest that a diet rich in green leafy vegetables may slow the progression of dry AMD.
Wet AMD can be treated with a type of medication called anti-VEGF medication, which aims to stop your vision getting worse by helping prevent further blood vessels developing. In some cases laser surgery can also be used to destroy abnormal blood vessels.
Early diagnosis and treatment of wet AMD is essential in reducing the risk of severe loss of vision.
Reducing your risk
It is not always possible to prevent macular degeneration as it is not clear exactly what triggers the processes that cause the condition.
Your risk of developing the condition is also closely linked to things such as your age and whether you have a family history of the condition.
However, you may be able to reduce your risk of developing AMD, or help prevent it getting worse, by:
if you smoke
eating a healthy diet high with plenty of fruit and vegetables
moderating your consumption of alcohol
trying to achieve or maintain a healthy weight
wearing UV-absorbing glasses when outside for long periods
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Juvenile macular degeneration
In rare cases, macular degeneration affects younger people. This is sometimes known as juvenile macular degeneration.
It can be present at birth or develop later, but it is almost always caused by an inherited genetic disorder, such as:
Stargardt's disease – the most common cause of juvenile macular degeneration, which can start in childhood or early adulthood.
Best's disease (also known as Best's vitelliform macular dystrophy).
Sorsby's dystrophy – often begins between the ages of 30 and 40 and causes some loss of vision.
Find out about eye tests, protecting your eyes from injury, contact lens safety and laser eye surgery
Symptoms of macular degeneration
Age-related macular degeneration (AMD) is not a painful condition. In fact, some people do not even realise there is a problem until their symptoms become more severe.
The main symptom of macular degeneration is blurring of your central vision. In particular, it results in:
loss of visual acuity – visual acuity is the ability to detect fine detail, for example when you read or drive
loss of contrast sensitivity – contrast sensitivity is the ability to see less well-defined objects, such as faces, clearly against the background
distortion of central vision – images, writing or faces can become distorted in the centre (this is most commonly associated with wet AMD)
Your peripheral vision (outer vision) is not affected.
If you wear glasses, your central vision will still be blurred if you have macular degeneration.
Both eyes tend to be affected by AMD eventually, although you may only notice problems in one eye to begin with.
Dry age-related macular degeneration
If you have dry AMD, it may take 5-10 years before your symptoms significantly affect your daily life.
Sometimes, if only one of your eyes is affected, your healthy eye will compensate for any blurring or loss of vision. This means it will take longer before your symptoms become noticeable.
You may have dry AMD if you find that:
you need brighter light than normal when reading
it is difficult to read printed or written text (because it appears blurry)
colours appear less vibrant
you have difficulty recognising people's faces
your vision seems hazy, or less well defined
If you are experiencing any of these symptoms, you should make an appointment with your GP or optometrist (a healthcare professional trained to recognise signs of eye problems).
Wet age-related macular degeneration
In most cases wet AMD develops in people who have had a previous history of dry AMD.
If you have wet AMD, any blurring in your central vision suddenly worsens.
You may also experience other symptoms, such as:
visual distortions – for example, straight lines may appear wavy or crooked
blind spots – which usually appear in the middle of your visual field and become larger the longer they are left untreated
– seeing shapes, people and/or animals that are not really there
Seek immediate medical assistance if you experience any sudden changes in your vision such as those described above. It may be a sign you have wet AMD, which needs to be treated as soon as possible to help stop your vision getting worse.
If you require immediate medical attention, you will either need to book an emergency appointment with an optometrist or visit your local accident and emergency (A&E) department.
AMD can cause your vision to become hazy and blind spots to develop in the middle of your visual field
Causes of macular degeneration
Age-related macular degeneration (AMD) is caused by a problem with part of the eye called the macula. The macula is the spot at the centre of your retina (the nerve tissue lining the back of your eye).
The macula is the part of your eye where incoming rays of light are focused. The macula plays an essential role in helping you see things directly in front of you and is used for close, detailed activities, such as reading and writing.
Dry age-related macular degeneration
As you get older, the layer of tissue underneath your retina can start to thicken. This means your retina can no longer exchange nutrients and waste products as efficiently as it used to.
Waste products start to build up in your retina and form small deposits, known as drusens. A build-up of drusen, combined with a lack of nutrients, causes the light cells in your macula to become damaged and stop working.
If the light cells in your macula are damaged, your central vision will become blurry and less well-defined.
Wet age-related macular degeneration
In cases of wet AMD, tiny new blood vessels begin to grow underneath the macula.
It is thought these blood vessels form as a misguided attempt by the body to clear away the waste products from the retina.
Unfortunately the blood vessels form in the wrong place and actually cause more harm than good. They can leak blood and fluid into the eye, which can cause scarring and damage to your macula.
This then causes the more serious symptoms of wet AMD to develop, such as visual distortion and blind spots.
Exactly what triggers the processes that lead to AMD is unclear, but a number of things are known to increase the risk factors of developing it. These are described below.
The older a person gets, the more likely they are to develop at least some degree of AMD.
Most cases start developing in people aged 50 or over and then rise sharply with age. It is estimated that one in every 10 people over 65 have some signs of AMD.
Cases of AMD have been known to run in families. If your parents or siblings develop AMD, it is thought that your risk of getting it is increased.
This would suggest certain genes you inherit from your parents may increase your risk of AMD. But exactly which genes are involved and how they are passed through families is unclear.
Smoking is a significant risk factor for AMD. In general, people who smoke are up to four times more likely to develop AMD than those who have never smoked.
The longer you have been smoking, the greater the risk. People who smoke and who also have a family history of AMD have an even greater risk.
Women are more likely to develop AMD than men, but this could simply be because women tend to live longer than men.
Studies have found rates of AMD are highest in white and Chinese people, and lower in black people. This again could be the results of genetics.
Possible risk factors
A number of other factors that may increase your risk of developing AMD have also been identified, but a link with the condition has not yet been proven.
It is possible that drinking more than four units of alcohol a day over the course of many years may increase your risk of having early AMD. One unit of alcohol is approximately half a pint of standard beer or lager, or one 25ml serving of spirits.
If you are exposed to lots of sunlight during your lifetime, your risk of developing macular degeneration may be increased. To protect yourself, you should wear UV-absorbing sunglasses if you are outside for a long time in bright sunlight.
Some studies have reported that being obese – having a body mass index (BMI) of 30 or greater – may increase your chance of developing AMD.
High blood pressure and heart disease
There is some limited evidence that having a history of high blood pressure or coronary heart disease may increase your risk of developing AMD.
Diagnosing macular degeneration
In some cases early age-related macular degeneration (AMD) may be detected before it begins to cause any symptoms, during a routine eye test.
If you are experiencing symptoms of macular degeneration, visit your GP or make an appointment with an optometrist (a healthcare professional trained to recognise signs of eye problems). Find your nearest optician.
If there is a sudden change in your vision, visit your nearest accident and emergency (A&E) department.
If your GP or optometrist suspects macular degeneration, you will be referred to an ophthalmologist (a medical doctor who specialises in diagnosing and treating eye conditions).
Your appointment will usually be at an eye department in a hospital. If travelling by car, ask someone else to drive you because you may be given eye drops during the appointment that make your vision blurry.
Your ophthalmologist will first carry out a routine check of your eyes. You will be given eye drops to enlarge your pupils. These take around half an hour to start working, and may make your vision blurry or your eyes sensitive to light. The effect will wear off after a few hours.
Your ophthalmologist will look at the back of your eyes where your retina and macula are located, using a magnifying device with a light attached to it. They will look for any abnormalities around your retina.
The ophthalmologist will then carry out a series of tests to confirm a diagnosis of macular degeneration.
One of the first tests involves asking you to look at a special grid, known as an Amsler grid. The grid is made up of vertical and horizontal lines, with a dot in the middle.
If you have macular degeneration, it is likely some of the lines will appear faded, broken or distorted. Telling your ophthalmologist which lines are distorted or broken will give them a better idea of the extent of the damage to your macula.
As the macula controls your central field of vision, it is usually the lines nearest to the centre of the grid that appear distorted.
The College of Optometrists produces a leaflet on macular degeneration that includes an Amsler grid you can print off and use at home to help you check for possible signs of AMD.
As part of your diagnosis, your ophthalmologist will need to photograph your retinas to see what damage, if any, macular degeneration has caused. This will confirm the diagnosis and prove useful in planning your treatment. There are several different ways of taking pictures of the retinas.
A fundus camera is a special camera used to take photographs of the inside of your eye. The camera can capture colour stereoscopic (three-dimensional) images of your macula. Your ophthalmologist can then look at the different layers of your retina to see what damage, if any, has occurred.
An angiography is an examination that creates detailed images of your blood vessels and the blood flow inside them. A special dye is injected into your blood vessels and pictures are taken that show any abnormalities inside them.
The angiography can confirm which type of AMD you have and may be done if your ophthalmologist suspects wet AMD.
During a fluorescein angiography, the ophthalmologist will inject a special dye, called fluorescein, into a vein in your arm.
Over the next 10 minutes they will use a magnifying device to look into your eyes, and take a series of pictures using a special camera.
These images will allow your ophthalmologist to see if any of the dye is leaking from the blood vessels behind your macula. If it is, this may confirm you have wet AMD.
Indocyanine green (ICG) angiography
The technique used for an ICG angiography is the same as for fluorescein angiography, but the dye is different. ICG is used as an alternative dye to fluorescein and may be used as it can highlight slightly different problems in your eyes.
Optical coherence tomography
Optical coherence tomography (OCT) uses special rays of light to scan your retina and produce an image of it. This can provide your ophthalmologist with detailed information about your macula. For example, it will tell them whether your macula is thickened or abnormal in any way, and whether any fluid has leaked into the retina.
Staging of AMD
Once these tests have been completed the ophthalmologist should be able to tell you how far your AMD has progressed.
Dry AMD has three main stages:
Early AMD – in this stage there may be many small collections of waste products (drusen) inside the eye, or fewer medium-sized drusen, or some minor damage to your retina. Early AMD may not cause any noticeable symptoms.
Intermediate AMD – there may be some larger drusen inside the eye or some tissue damage to the outer section of the macula. People with intermediate AMD will have a blurred spot in the centre of their vision.
Advanced AMD – the centre of the macula is now damaged. People with advanced AMD will have a much larger blurred spot and have difficulties reading and recognising faces.
Wet AMD is always regarded as an advanced form of AMD.
Treating macular degeneration
There is currently no cure for either type of age-related macular degeneration (AMD).
With dry AMD, the deterioration of vision can be very slow. You will not go completely blind as a result of the condition and your peripheral (outer) vision should not be affected.
Help is available to make tasks such as reading and writing easier. Getting practical help may improve your quality of life and make it easier for you to carry out daily activities.
You may be referred to a low vision clinic. These clinics can provide useful advice and practical support to help minimise the effect dry AMD has on your life. For example, things that may make it easier for you to carry out close, detailed work include:
large print books
intensive (very bright) reading lights
There are also a number of devices that can help you adjust to low vision, such as screen-reading software on your computer so you can ‘read’ emails, documents and browse the internet.
Diet and nutrition
There is some evidence that a diet high in vitamins A (beta-carotene), C, and E – as well as substances called lutein and zeaxanthin – may slow the progression of dry AMD and reduce your risk of getting wet AMD in selected cases. Talk to an ophthalmologist about whether these could help you.
Foods high in vitamins A, C, and E include:
green leafy vegetables
Green leafy vegetables are also a good source of lutein, as are peas, mangos and sweetcorn.
So far, there is no definitive proof that this type of diet is effective in everyone with dry AMD, but eating a diet as healthy as this will bring other important health benefits.
Dietary supplements are also available, some of which claim to specifically improve eye health. It's important to check with your GP before taking supplements because they are not suitable for everyone.
For more information, see vitamins and minerals and the Macular Society’s factsheet on Nutrition and your eyes (PDF, 71kb).
There are two main treatment options for wet AMD:
anti-VEGF medication to prevent the growth of new blood vessels in the eye
laser surgery to destroy abnormal blood vessels in the eye
These treatments are described below.
Anti-VEGF medication is a treatment that can help stop the progression of wet AMD.
VEGF stands for 'vascular endothelial growth factor'. It is one of the chemicals responsible for the growth of new blood vessels that form in the eye as a result of wet AMD. Anti-VEGF medicines work by blocking this chemical and stopping it from producing the blood vessels.
The anti-VEGF medication has to be injected into your eye using a very fine needle. You will be given local anaesthetic eye drops so the procedure does not hurt. Most people tolerate this very well with minimal discomfort.
Anti-VEGF medication is primarily used to stop wet AMD from getting worse. However, in some cases it has also been shown to shrink the blood vessels in the eye and restore some of the sight lost as a result of macular degeneration. It is important to be aware that your sight will not be restored completely, and not everyone will see an improvement.
Current recommendations are that ranibizumab and aflibercept should only be used if:
your visual acuity (your ability to detect fine details or small distances) is between 6/12 and 6/96 – this means your central vision is at least good enough to see something at six metres that a person with normal eyesight could see at 96 metres
there is no permanent damage to the fovea, which is the part of the eye that helps people see things in sharp detail
the area affected by AMD is no larger than 12 times the size of the area inside the eye where the optic nerve connects to the retina
there are signs the condition has been getting worse
Your ophthalmologist should be able to tell you if you are suitable for treatment with ranibizumab or aflibercept.
Other anti-VEGF medicines – such as pegaptanib – are also available, but you will usually have to pay for these treatments and these medicines can be very expensive. For example, a two year course of pegaptanib can cost over £9,000.
Studies show that ranibizumab (brand name Lucentis) can help slow loss of visual acuity in over 90% of people, and may even increase visual acuity in around a third of people.
You will be given one injection of ranibizumab into your affected eye once a month, for three months. After this time, you will be monitored during a 'maintenance phase'.
If your vision deteriorates and is thought to be due to further leakage of fluid during this maintenance phase, you may be given another injection of ranibizumab. This monitoring will continue, and you will have injections as necessary, with at least one month in between injections.
If your condition does not show signs of improvement after treatment with ranibizumab, or continues to get worse, your treatment will be stopped.
Common side effects of ranibizumab include:
minor bleeding from your eye
minor discomfort in your eye
inflammation or irritation of the eye
feeling like there is something in your eye
increased pressure within your eye
For a full list of side effects, read the medicines information for ranibizumab.
Aflibercept (brand name Eylea) is a newer type of anti-VEGF medication for wet AMD and studies have shown that it is at least as effective as ranibizumab in treating people with the condition.
At first, you will be given one injection of aflibercept into your affected eye once a month, for three months. Injections will then be given once every two months. After a year of treatment, the intervals between injections can be extended depending on how well the medication is working.
On average, treatment with aflibercept tends to involve fewer injections and monitoring visits than treatment with ranibizumab.
Common side effects of aflibercept are similar to ranibizumab, including:
minor bleeding in your eye
minor discomfort in your eye
inflammation or irritation of the eye
feeling like there is something in your eye
increased pressure within your eye
Photodynamic therapy (PDT) was developed in the 1990s. It involves having a light-sensitive medicine called verteporfin injected into a vein in your arm. The injection lasts around 10 minutes.
The verteporfin attaches itself to the abnormal blood vessels in your macula (the part of your eye responsible for central vision).
A low-powered laser is then shone into your damaged eye, over a circular area just larger than the affected area in your eye. This usually takes around one minute.
The light from the laser is absorbed by the verteporfin and activates it. The activated verteporfin destroys the abnormal vessels in your macula while reducing harm to other delicate tissues in your eye.
Destroying the blood vessels stops them leaking blood or fluid, preventing damage and therefore stopping the macular degeneration from getting worse.
You may need this treatment every few months to ensure any new blood vessels that start growing are kept under control.
PDT is not suitable for everyone. It will depend on where the blood vessels are growing and how severely they have affected your macula.
PDT may be suitable if your visual acuity is 6/60, or better. This means you can see from a distance of six metres what someone with normal vision can see from a distance of 60 metres. Around one in five people with wet AMD are suitable for PDT.
Laser photocoagulation can also be used to treat some cases of wet AMD.
This type of surgery is only suitable if the abnormal blood vessels are not close to the fovea, as performing surgery close to this part of the eye can cause permanent vision loss.
Around one in seven people are suitable for treatment with laser photocoagulation.
Laser photocoagulation uses a powerful laser to burn sections of the retina. These sections harden, which prevents the blood vessels from moving up into the macula.
The surgery is performed under local anaesthetic to numb the eye, so it is not painful.
You should be aware that an inevitable side effect of laser photocoagulation is that you will develop a permanent black or grey patch in your field of vision. This loss of vision is usually (but not necessarily always) less severe than untreated wet AMD.
If you're considering laser photocoagulation, you need to discuss the pros and cons of this treatment with the doctor in charge of your care.
As the results of laser photocoagulation tend to be less effective than the other treatments discussed above, it now tends to only be used in people who are unable to be treated with anti-VEGF medication or PDT.
Radiotherapy has been used in the past for treating wet AMD with varying results.
Recently, radiotherapy has been investigated to see whether its use in combination with anti-VEGF injections may be of benefit in reducing the number of injections needed. Although early results of some studies are encouraging, the longer term benefits are still unknown.
Radiotherapy may be available as part of a clinical trial and you will need to be advised by your ophthalmologist as to whether you may be suitable for the treatment.
Newer types of surgery
In recent years two new surgical techniques have been developed to treat wet AMD. These are:
macular translocation – where the macula is repositioned over a healthier section of the eyeball not affected by abnormal blood vessels
lens implantation – where the lens of the eye is removed and replaced with an artificial lens designed to enhance central vision
Both approaches tend to achieve better results in restoring vision than laser surgery, but there are also disadvantages, such as:
access to these treatments is limited and may only be available in the context of a clinical trial
as these are new techniques it is uncertain whether they are safe and effective in the long term
they carry a higher risk of serious complications than laser surgery
The National Institute for Health and Care Excellence (NICE) has more information on macular translocation and lens implantation.
Complications of macular degeneration
Being told that you have age-related macular degeneration (AMD) can be frustrating and upsetting, as simple everyday tasks such as reading become more difficult.
You should speak to your GP if you are finding your macular degeneration is having a significant effect on your daily life. They should be able to put you in touch with local support groups who can provide guidance and practical help.
Alternatively, you could call the Macular Society helpline on 0300 3030 111 (lines are open 9am-5pm, Monday to Friday), or the Royal National Institute for Blind People helpline on 0303 123 9999 (lines are open 8.45am-5.30pm, Monday to Friday).
Depression and anxiety
Having to cope with losing part of your vision and coming to terms with the loss of some of your independence can be difficult and it can affect your mental health.
It is estimated that around a third of people with AMD may have some form of depression or anxiety.
If you are struggling with the changes to your life, you should speak to your GP or ophthalmologist (your eye specialist). They will be able to discuss treatment options with you, such as counselling, or they can refer you to a mental health professional for further assessment.
You will need to inform the DVLA and your insurance company if you drive and are diagnosed with AMD because the condition may affect your ability to drive.
If your eyesight is only minimally affected, it may still be safe for you to drive a vehicle. However, you may have to perform a series of sight tests to prove this. Central vision is very important for driving and if you do not meet the standards set by the DVLA, you will not be able to drive.
See macular degeneration and driving on GOV.UK for more information.
Some people with macular degeneration can experience visualhallucinations caused by their low vision. This is known as Charles Bonnet syndrome. It is estimated that about one in every 10 people with AMD experience Charles Bonnet syndrome.
As AMD can prevent you from receiving as much visual stimulation as you are used to, your brain can sometimes compensate by creating fantasy images, or using images stored in your memory. These are known as hallucinations.
The hallucinations you experience may include unusual patterns or shapes, animals, faces or an entire scene. They can be either black and white or colour, and may last from a few minutes to several hours. They are usually pleasant images, although they may be unsettling and scary to experience.
Many people with Charles Bonnet syndrome do not tell their GP about their symptoms because they worry it may be a sign of a mental condition. However, the hallucinations that you experience with this syndrome are usually the result of a problem with your vision and not a reflection of your mental state.
Speak to your GP if you experience any kind of visual hallucination. There are ways they can help you learn how to cope with your hallucinations. The hallucinations will usually last for around 18 months, although for some people they may last years.