Author: Dr Val Phua
Estimated reading time: 11–13 minutes
Age-Related Macular Degeneration Affects Central Vision
Age-related macular degeneration, commonly known as AMD, is a condition affecting the macula—the central part of the retina responsible for detailed vision.
AMD may make it difficult to:
- Read
- Recognise faces
- Drive
- See fine details
- Distinguish colours clearly
- Adjust between bright and dim environments
The condition generally affects central rather than peripheral vision. Even in advanced AMD, patients usually retain some side vision and do not become completely blind. However, severe central visual loss can still have a major effect on independence and quality of life.
AMD is usually painless. Early disease may cause no symptoms, which is why regular dilated eye examinations become increasingly important with age.
What Is the Macula?
The retina is a thin layer of light-sensitive nerve tissue lining the back of the eye.
At its centre is the macula, which provides the sharp vision needed for:
- Reading small print
- Recognising faces
- Driving
- Seeing colour
- Performing detailed tasks
The very centre of the macula is known as the fovea. It provides the finest vision.
AMD damages the photoreceptor cells, retinal pigment epithelium and supporting tissues around the macula. As the disease progresses, central vision may become distorted, blurred or missing.
What Are Drusen?
Drusen are small yellow deposits that accumulate beneath the retina.
A few small drusen can occur as part of normal ageing and do not necessarily mean that a person has significant AMD. Larger or more numerous drusen—particularly when accompanied by pigmentary changes—may indicate a higher risk of progression.
Drusen are usually discovered during a dilated retinal examination or on retinal imaging before the patient notices symptoms.
The Two Main Types of AMD
AMD is broadly divided into:
- Dry AMD
- Wet AMD
Most patients begin with the dry form. A smaller proportion develop wet AMD, which may cause more rapid and severe central visual loss.
Dry AMD
Dry AMD, also known as non-neovascular AMD, develops gradually.
It occurs when the macular tissues and supporting retinal pigment epithelium deteriorate over time.
Dry AMD is classified into early, intermediate and late stages.
Early Dry AMD
Early AMD is characterised by small or medium-sized drusen, sometimes with mild pigmentary changes.
Most patients have no symptoms and maintain good vision.
Treatment usually involves:
- Monitoring
- Addressing modifiable risk factors
- Maintaining a healthy lifestyle
- Regular dilated retinal examinations
AREDS2 supplements are not routinely beneficial for people with no AMD or only early AMD.
Intermediate Dry AMD
Intermediate AMD generally involves larger drusen or more significant pigmentary changes.
Patients may begin to notice:
- Difficulty reading in dim light
- Slower adjustment from bright to dark surroundings
- Reduced contrast
- Colours appearing less bright
- Mild distortion
- Needing stronger lighting to read
Patients with intermediate AMD may benefit from AREDS2 supplements to reduce the risk of progression to advanced disease.
Geographic Atrophy
The advanced form of dry AMD is known as geographic atrophy, or GA.
In geographic atrophy, clearly defined areas of retinal cells and supporting tissue gradually disappear.
Patients may develop:
- Missing patches in the central vision
- Difficulty recognising faces
- Words disappearing while reading
- Slow reading speed
- Poor vision in dim lighting
- Reduced contrast
- Difficulty driving, particularly at night
Geographic atrophy may initially develop beside the fovea and gradually enlarge towards the centre. Progression into the fovea causes more substantial central visual loss.
In the United States, intravitreal complement-inhibitor treatments have been approved to slow the enlargement of geographic-atrophy lesions. These treatments require repeated eye injections and are intended to slow progression rather than restore retinal tissue or recover vision already lost. Availability and regulatory approval vary between countries, and the potential benefit must be balanced against injection-related and treatment-specific risks.
Wet AMD
Wet AMD is also called:
- Neovascular AMD
- Exudative AMD
- Macular neovascularisation
It develops when abnormal blood vessels grow beneath or within the retina.
These fragile vessels may:
- Leak fluid
- Bleed
- Swell the macula
- Form scar tissue
- Damage the photoreceptors
Wet AMD may cause a sudden or progressive change in central vision and requires prompt assessment.
The main treatment is anti-vascular endothelial growth factor, or anti-VEGF, medication injected into the eye. Anti-VEGF treatment reduces leakage and bleeding from abnormal blood vessels and can stabilise—and sometimes improve—vision.
Can Dry AMD Turn into Wet AMD?
Yes.
A person with dry AMD may develop wet AMD in one or both eyes.
The warning signs include:
- New distortion
- Straight lines becoming wavy
- Sudden central blur
- A grey or dark central patch
- Objects appearing smaller or misshapen
- A rapid change in reading ability
These symptoms require prompt retinal assessment. Earlier treatment generally provides a better opportunity to preserve central vision.
What Are the Symptoms of AMD?
Symptoms depend on the stage and type of disease.
Early Symptoms
Early AMD may cause no symptoms.
When symptoms begin, patients may notice:
- Needing brighter light to read
- Reduced contrast
- Difficulty adjusting to dim environments
- Colours appearing less vivid
- Mild central blur
Distorted Vision
Straight objects may appear:
- Wavy
- Bent
- Broken
- Uneven
Examples include:
- Door frames
- Window grilles
- Lines of text
- Floor tiles
- Road markings
This distortion is known as metamorphopsia and may indicate fluid or structural change within the macula.
Missing Central Vision
Advanced disease may produce a grey, blurred or missing area in the centre of vision.
Patients may report:
- Being able to see a person’s hair but not their face
- Letters disappearing while reading
- Difficulty pouring liquids accurately
- Problems recognising money or medication labels
Reduced Vision in Dim Light
AMD may make it difficult to:
- Read in restaurants
- Walk from sunlight into a dim room
- Drive at dusk or night
- Distinguish objects with similar contrast
Early and intermediate dry AMD can affect dark adaptation before central visual acuity becomes substantially reduced.
When Should I Seek Urgent Assessment?
Arrange prompt ophthalmic assessment if you notice:
- New distortion of straight lines
- Sudden central blurred vision
- A new dark, grey or missing patch
- A rapid reduction in reading ability
- A sudden difference between the two eyes
- New visual symptoms in an eye already known to have AMD
Wet AMD may progress without pain or external redness.
Do not wait for a routine appointment if your central vision changes suddenly.
Who Is at Greater Risk of AMD?
Increasing Age
Age is the strongest risk factor. AMD becomes more common after age 50 and especially in older adults.
Smoking
Smoking is one of the most important modifiable risk factors.
It contributes to oxidative stress, vascular injury and inflammation and is associated with a greater risk of AMD progression.
Stopping smoking benefits both eye health and general health.
Family History and Genetics
AMD has a strong genetic component.
Risk is higher if a parent or sibling has the condition, although having a family history does not mean that AMD is inevitable.
Cardiovascular and Metabolic Health
High blood pressure, high cholesterol, cardiovascular disease and a higher body mass index have been associated with AMD risk in observational research.
Maintaining good systemic health is sensible, although treating these conditions does not guarantee that AMD will be prevented.
Diet
A diet low in leafy green vegetables, antioxidants and fish may be associated with higher risk.
Dietary patterns that support cardiovascular health may also support retinal health.
Does High Myopia Cause AMD?
High myopia can cause a separate condition known as myopic macular degeneration.
Both conditions affect the macula but arise through different mechanisms.
Myopic macular degeneration is related to elongation and stretching of the eye, while AMD is primarily associated with ageing, genetics and other risk factors.
Some patients may have both conditions, requiring careful retinal imaging to determine the cause of visual changes.
How Is AMD Diagnosed?
Visual Acuity
Vision is measured using an eye chart.
A patient may still have relatively good visual acuity during early AMD, particularly when the fovea remains unaffected.
Dilated Retinal Examination
Dilating drops enlarge the pupils so that the macula and surrounding retina can be examined.
The ophthalmologist looks for:
- Drusen
- Pigmentary changes
- Retinal atrophy
- Fluid
- Bleeding
- Abnormal blood vessels
- Scar tissue
Optical Coherence Tomography
Optical coherence tomography, or OCT, uses light waves to create detailed cross-sectional images of the retina.
It can identify:
- Drusen
- Retinal thinning
- Geographic atrophy
- Fluid beneath or within the retina
- Pigment epithelial detachments
- Abnormal neovascular tissue
- Treatment response
OCT is painless and is one of the most important tests for diagnosing and monitoring AMD.
OCT Angiography
OCT angiography can display retinal and choroidal blood vessels without injecting dye.
It may identify abnormal neovascular networks and complement ordinary OCT.
Fluorescein Angiography
During fluorescein angiography, dye is injected into a vein and photographs are taken as the dye circulates through the retinal blood vessels.
This may help determine:
- Whether abnormal vessels are present
- Where leakage is occurring
- The extent and activity of wet AMD
Indocyanine Green Angiography
Indocyanine green angiography may be particularly useful when abnormal vessels lie deeper beneath the retina or when polypoidal choroidal vasculopathy is suspected.
This is relevant in Asian populations, in whom polypoidal disease forms an important part of the differential diagnosis for wet macular disease.
Fundus Autofluorescence
Fundus autofluorescence imaging evaluates the health and distribution of retinal pigment epithelial cells.
It is particularly helpful in documenting and monitoring geographic atrophy.
How Is Dry AMD Treated?
Treatment depends on the stage.
Early Dry AMD
There is no injection or operation routinely recommended for early dry AMD.
Management generally includes:
- Regular monitoring
- Smoking cessation
- A balanced diet
- Cardiovascular risk management
- Exercise where medically appropriate
- Prompt reporting of visual changes
Intermediate AMD
AREDS2 supplements may reduce the risk of intermediate AMD progressing to advanced AMD.
The AREDS and AREDS2 studies found an approximately 25% reduction in progression to advanced AMD among people at sufficiently high risk. The supplements do not prevent AMD from starting and are not ordinary multivitamins.
Geographic Atrophy
Management may include:
- Regular retinal imaging
- Monitoring for conversion to wet AMD
- AREDS2 supplements when appropriate
- Low-vision support
- Discussion of newer complement-inhibitor injections where available and clinically appropriate
Complement-inhibitor treatment slows lesion growth rather than restoring vision. The decision requires a discussion of treatment burden, expected benefit and possible complications.
What Is the AREDS2 Formula?
The original research formulation contains:
| Ingredient | Daily amount |
|---|---|
| Vitamin C | 500 mg |
| Vitamin E | 400 IU |
| Zinc | 80 mg |
| Copper | 2 mg |
| Lutein | 10 mg |
| Zeaxanthin | 2 mg |
Commercial formulations may vary, so patients should compare the label with the evidence-based formula and follow their ophthalmologist’s advice.
Who Should Take AREDS2?
AREDS2 may be recommended for patients with:
- Intermediate AMD in one or both eyes
- Advanced AMD in one eye and less advanced AMD in the other
- Selected cases of late dry AMD, depending on the retinal findings
AREDS2 is not routinely indicated simply because someone is older or has a family history of AMD.
It has not been shown to:
- Prevent AMD from beginning
- Eliminate drusen
- Restore vision already lost
- Treat active wet AMD
- Prevent cataracts
The correct stage should be confirmed by an eye-care professional before supplementation begins.
Why Is AREDS2 Preferred to the Original AREDS Formula?
The original AREDS formula contained beta-carotene.
Beta-carotene supplementation was associated with an increased risk of lung cancer in current and former smokers. AREDS2 replaced beta-carotene with lutein and zeaxanthin.
Current and former smokers should avoid the original beta-carotene-containing formulation and use AREDS2 if supplementation is indicated.
Are AREDS2 Supplements Completely Safe?
AREDS2 contains high doses of vitamins and minerals and may:
- Cause stomach discomfort
- Interact with medication
- Affect the absorption of some antibiotics
- Increase bleeding concerns in selected patients taking anticoagulant or antiplatelet medication
- Add unnecessarily to other supplements already being taken
Patients should tell their doctor about all medication, vitamins, herbal remedies and supplements before starting AREDS2. Singapore HealthHub specifically advises caution with blood-thinning medication and certain antibiotics.
How Is Wet AMD Treated?
Anti-VEGF Eye Injections
VEGF is a protein that encourages abnormal blood-vessel growth and leakage.
Anti-VEGF medication blocks this signal and can:
- Reduce retinal fluid
- Reduce bleeding
- Stabilise vision
- Improve vision in some patients
- Reduce the risk of severe central visual loss
Treatment is delivered through a very fine needle into the vitreous cavity.
The eye is numbed and cleaned before the injection. Patients commonly feel pressure rather than sharp pain.
How Many Injections Are Needed?
Wet AMD is usually a chronic condition.
Many patients begin with more frequent injections, followed by an individualised schedule based on:
- Vision
- OCT findings
- Fluid or bleeding
- Treatment response
- The medication used
- Recurrence pattern
Treatment approaches include fixed dosing, treatment as needed and treat-and-extend protocols.
Stopping treatment prematurely may allow abnormal vessels to reactivate and cause irreversible retinal damage.
Are Eye Injections Safe?
Intravitreal injections are widely performed and serious complications are uncommon.
Potential risks include:
- Infection inside the eye
- Inflammation
- Retinal tear or detachment
- Vitreous bleeding
- Temporary or sustained elevation of eye pressure
- Surface bleeding where the needle entered
A small red patch on the white of the eye is common and usually harmless. Severe pain, worsening redness, marked light sensitivity or reduced vision after an injection requires urgent review.
Photodynamic Therapy
Photodynamic therapy, or PDT, uses a light-activated medicine called verteporfin.
The medicine is injected into a vein and activated with a specialised laser directed at the abnormal blood vessels.
PDT is now used less often than anti-VEGF monotherapy but may be useful in selected cases, including certain forms of polypoidal choroidal vasculopathy or disease that does not respond adequately to injections alone.
Can Wet AMD Be Cured?
Wet AMD cannot currently be permanently cured.
Anti-VEGF treatment controls the abnormal vessels but does not remove the underlying tendency for them to reactivate.
Some patients require long-term or repeated treatment. Regular monitoring is essential even when the retina appears dry and vision is stable.
How Do I Use an Amsler Grid?
An Amsler grid is a square pattern of straight lines with a central dot. It helps patients with known macular disease monitor their central vision at home.
Step-by-Step
- Wear your normal reading glasses.
- View the grid in good lighting.
- Hold it at your usual reading distance.
- Cover one eye without pressing on it.
- Look directly at the central dot.
- While keeping your gaze on the dot, notice whether any lines appear:
- Wavy
- Blurred
- Broken
- Missing
- Dark
- Repeat with the other eye.
Contact your ophthalmologist promptly if you notice a new change.
An Amsler grid does not replace retinal examinations and should not be used as a universal screening test in people without known macular disease. It is most useful for monitoring patients already considered at risk.
Can Lifestyle Changes Prevent AMD?
No lifestyle measure can guarantee prevention, but certain habits may reduce modifiable risk and support general retinal health.
Stop Smoking
Smoking cessation is the most important modifiable step.
Eat a Balanced Diet
Include:
- Dark green leafy vegetables
- Colourful fruit and vegetables
- Fish
- Nuts and seeds
- Whole grains
- Healthy unsaturated fats
A healthy diet does not replace AREDS2 when the supplement is clinically indicated.
Control Blood Pressure and Cholesterol
Good cardiovascular health supports the blood vessels supplying the eye.
Exercise Regularly
Exercise supports cardiovascular and metabolic health. The appropriate amount should be discussed with a doctor when significant medical conditions are present.
Maintain a Healthy Weight
Obesity and metabolic disease may contribute to systemic inflammation and vascular risk.
Protect the Eyes Outdoors
Sunglasses with appropriate ultraviolet protection reduce glare and protect the eyes from UV exposure, although sunglasses alone have not been proven to prevent AMD.
Does Blue Light from Screens Cause AMD?
Current evidence does not show that normal use of phones, computers or tablets causes age-related macular degeneration.
Digital screens can cause eye strain and reduce blinking, but these effects are different from macular degeneration.
Blue-light-filtering glasses have not been proven to prevent AMD.
Can Cataract Surgery Worsen AMD?
Cataracts and AMD frequently coexist because both become more common with age.
Cataract surgery improves vision by removing the cloudy natural lens, but it does not treat retinal damage from AMD.
Patients with AMD may still benefit from cataract surgery if the cataract contributes meaningfully to blur or glare. The expected improvement depends on the health of the macula.
Current evidence does not support avoiding necessary cataract surgery solely because AMD is present. Careful OCT assessment helps estimate the likely visual benefit.
Will AMD Make Me Completely Blind?
AMD primarily damages central vision.
Patients usually retain peripheral vision, allowing them to:
- Navigate familiar environments
- Detect large objects
- Maintain some independence
However, advanced bilateral disease can make reading, driving, recognising faces and detailed tasks extremely difficult.
Low-vision rehabilitation can help patients use their remaining sight more effectively.
Low-Vision Support
Patients with advanced AMD may benefit from:
- Magnifying devices
- Electronic readers
- Large-print material
- Improved lighting
- High-contrast settings
- Smartphone accessibility features
- Voice-control systems
- Orientation and mobility training
- Occupational therapy
- Low-vision rehabilitation
Referral should not be delayed until vision becomes extremely poor.
Frequently Asked Questions
Is AMD the same as a cataract?
No.
A cataract is clouding of the eye’s natural lens. AMD damages the retina at the back of the eye.
Cataract-related blur can usually be treated surgically, while AMD-related visual loss may not be fully reversible.
Does AMD affect both eyes?
AMD often affects both eyes, but the stage and rate of progression may differ considerably.
Can early AMD be reversed?
No treatment has been proven to remove drusen or restore the retina to its previous condition.
Treatment focuses on reducing progression risk and detecting conversion to advanced disease early.
Do ordinary multivitamins prevent AMD?
No.
AREDS2 is a specific high-dose formulation studied in defined stages of AMD. Ordinary multivitamins do not contain the same ingredients and doses.
Should everyone over 50 take AREDS2?
No.
AREDS2 is recommended according to retinal findings, not age alone.
Can fish oil treat AMD?
AREDS2 research found that adding omega-3 fatty acids did not reduce progression to advanced AMD.
Can wet AMD improve after injections?
Yes.
Many patients achieve stabilisation, and some experience meaningful visual improvement. The outcome depends on how early treatment begins, the condition of the photoreceptors and how consistently treatment is continued.
Why is my vision still poor when the OCT is dry?
Fluid may have resolved while permanent photoreceptor damage, retinal atrophy or scar tissue remains.
A dry OCT indicates control of leakage but does not guarantee restoration of normal vision.
How often should AMD be reviewed?
The interval depends on the stage.
Early disease may be reviewed annually, while intermediate AMD generally requires closer monitoring. Wet AMD and geographic atrophy may require frequent imaging and treatment reviews.
The Bottom Line
Age-related macular degeneration damages the macula and affects central vision.
There are two main forms:
- Dry AMD, which usually progresses gradually and may develop into geographic atrophy
- Wet AMD, caused by abnormal leaking blood vessels and capable of causing rapid central visual loss
Important warning symptoms include:
- Straight lines becoming wavy
- New central blur
- A dark or missing central patch
- A sudden reduction in reading ability
AREDS2 supplements may reduce progression in selected patients with intermediate or advanced AMD, but they do not prevent AMD from starting and are not appropriate for everyone.
Wet AMD is usually treated with anti-VEGF injections. Early diagnosis and consistent treatment provide the best opportunity to preserve central vision.
New distortion or sudden central visual change should be assessed promptly—even when the eye is painless and does not look red.
References
- American Academy of Ophthalmology. Age-Related Macular Degeneration Preferred Practice Pattern. 2025.
- National Eye Institute. Age-Related Macular Degeneration.
- National Eye Institute. AREDS and AREDS2 Clinical Trials. Updated October 2025.
- National Eye Institute. Treatments for Wet AMD. Updated December 2024.
- American Society of Retina Specialists. Dry AMD and Geographic Atrophy.
- American Society of Retina Specialists. Wet AMD and Macular Neovascularisation.
- HealthHub Singapore. AREDS and AREDS2 Supplements. Updated March 2026.
- US Food and Drug Administration. Complement-Inhibitor Treatments for Geographic Atrophy.
