Macular Degeneration: Understanding Your Risk, Your Diagnosis, and Your Treatment Options

Macular degeneration — often called AMD (Age-Related Macular Degeneration) — is one of the leading causes of vision loss in adults over 50. It affects the macula, the central part of the retina responsible for sharp vision, reading, driving, recognizing faces, and color perception.

The frustrating part? AMD often develops quietly. Many patients don’t realize anything is wrong until their central vision has already begun to decline. But with earlier detection and modern treatments, we can slow or even stop progression in many cases.

Let’s walk through what AMD is, why it happens, how we detect it, and what treatments are available today.

Hereditary Risk: Does AMD Run in Families?

Yes — genetics play a significant role in macular degeneration.
If you have a parent or sibling with AMD, your risk is substantially higher. Certain gene variants (such as CFH and ARMS2) increase susceptibility to retinal inflammation and drusen formation.

Other risk factors compound hereditary risk:

• Age over 50

• Smoking (a major risk factor for progression)

• Poor diet or low antioxidant intake

• High blood pressure

• Light-colored eyes

• Excessive UV exposure

But heredity is not destiny — lifestyle and early monitoring can dramatically influence outcomes.

Dry vs. Wet Macular Degeneration: Understanding the Two Forms

Dry AMD (Atrophic / Non-Neovascular)

This is the most common form, accounting for about 85–90% of AMD cases.
In dry AMD:

• Drusen (yellow deposits) build up under the retina

• The macula slowly thins

• Vision changes occur gradually

                                                Dry AMD with Drusen                           

                                      Dry AMD with Geographic Atrophy      

Over time, dry AMD can progress to geographic atrophy, where patches of retinal cells permanently stop functioning — causing blind spots in central vision.

Wet AMD (Neovascular / Exudative)

Wet AMD is less common but more severe.
It occurs when abnormal blood vessels grow under the retina and begin:

• Leaking

• Bleeding

• Causing sudden distortion or blurred central vision

Untreated wet AMD can rapidly damage the macula, which is why early detection and immediate treatment are critical.

Prognosis: What Can Patients Expect?

While AMD cannot be “cured,” modern treatments are dramatically better than they were even 10 years ago.

• Dry AMD often progresses slowly over many years.

• Wet AMD can progress quickly, but with treatment, many patients maintain or even gain vision.

• Geographic atrophy is now treatable with new medications that slow progression.

The key is monitoring — both at home and regularly in the office — so that any change is caught early.

Monitoring at Home: What Patients Should Do

1. Amsler Grid

A simple square grid with a dot in the center.
Patients check one eye at a time, looking for:

• Wavy lines

• Missing areas

• Distortion

Any new change should trigger a call to the office immediately.

                Normal Amsler                            Abnormal Amsler

2. Pay Attention to Subtle Signs

These include:

• Difficulty reading

• Needing brighter light

• Trouble recognizing faces

• Straight lines appearing bent

Changes often creep up slowly — so consistent awareness matters.

In-Office Testing: How We Diagnose and Track AMD

Modern retinal imaging tools allow us to detect AMD earlier and follow it with incredible precision.

1. Macular OCT (Optical Coherence Tomography)

OCT is the backbone of AMD diagnosis. It creates ultra-high-resolution cross-sectional images of the retina, showing:

• Drusen

• Fluid or swelling

• Retinal thinning

• Geographic atrophy

                              Dry AMD with geographic atrophy

                                                          Wet AMD OCT

It is indispensable for distinguishing dry from wet AMD and monitoring response to treatment.

2. Fundus Autofluorescence (FAF)

FAF imaging highlights areas of metabolic stress in the retinal pigment epithelium (RPE). It is especially useful for:

• Detecting dry AMD changes early

• Tracking progression of geographic atrophy

• Differentiating healthy from compromised retinal tissue

This test helps us predict which areas may deteriorate next.

3. Fluorescein Angiography (IVFA)

In IVFA, a dye is injected into a vein and photographed as it travels through the retinal blood vessels.
This test is essential for:

• Confirming wet AMD

• Identifying leaking vessels

• Mapping abnormal neovascularization

IVFA provides a true “roadmap” of abnormal blood flow.

4. OCT Angiography (OCTA)

OCTA creates detailed, dye-free images of the retinal and choroidal vasculature.
It helps detect:

• Early neovascular membranes

• Subtle changes too small for IVFA

• Progression of dry AMD toward wet

OCTA is quick, non-invasive, and incredibly sensitive.

Treatment Options: What We Can Do Today

1. Treatment for Dry AMD

AREDS2 Supplements

For intermediate AMD or significant drusen, the AREDS2 formulation can reduce the risk of progression.
It includes:

• Vitamin C

• Vitamin E

• Zinc

• Copper

• Lutein

• Zeaxanthin

Dietary & Lifestyle Improvements

A heart-healthy diet is also an eye-healthy diet.

Encourage:

• Leafy greens

• Brightly colored vegetables

• Omega-3 fatty acids (fish, flaxseed, walnuts)

• Smoking cessation

• UV protection

New Treatments for Geographic Atrophy

Two injectable medications can now slow the progression of GA:

• Syfovre (pegcetacoplan)

• Izervay (avacincaptad pegol)

These do not restore lost vision, but they preserve remaining retinal cells — buying patients time and protecting central vision for longer.

2. Treatment for Wet AMD

The mainstay of treatment is anti-VEGF injections, which block the growth of abnormal blood vessels and stop leakage.

Common anti-VEGF medications include:

• Eylea (aflibercept)

• Lucentis (ranibizumab)

• Avastin (bevacizumab)

• Vabysmo (faricimab)

• Eylea HD (aflibercept 8 mg)

Most patients require a series of injections, initially monthly, then gradually extending as the retina stabilizes.

Modern anti-VEGF therapy has truly changed the game — turning what used to be a blinding condition into a highly manageable disease.

The Bottom Line

Macular degeneration is common, hereditary, and potentially sight-threatening — but the tools we have today for early detection and treatment are extraordinarily powerful. Whether it’s dry AMD, early geographic atrophy, or wet AMD, every stage now has options to slow, stabilize, or treat the disease.

The most important step is staying proactive.
Regular exams, retinal imaging, and paying attention to small visual changes can make all the difference.

Author

Keith Kellum, MD Dr. Keith Kellum is a board certified ophthalmologist with over 25 years of experience. He has been very active and progressive in treating cataract, glaucoma and retinal diseases.