Age-Related Macular 

Degeneration 

What 

should know 
Age-Related Macular Degeneration: 

What you should know 

This booklet is for people with age-related macular degeneration 

(AMD) and their families and friends. It provides information 

about AMD and answers questions about its causes and 

symptoms. Diagnosis and types of treatment are described. 

The National Eye Institute (NEI) conducts and supports research 

that leads to sight-saving treatments and plays a key role in 

reducing visual impairment and blindness. The NEI is part of the 

National Institutes of Health (NIH), an agency of the U.S. 

Department of Health and Human Services. 

For more information about the NEI, contact: 

National Eye Institute 

National Institutes of Health 

2020 Vision Place 

Bethesda, MD 20892–3655 

Telephone: 301–496–5248 

E-mail: 2020@nei.nih.gov 

Website: www.nei.nih.gov 
Contents 

What is age-related macular degeneration? ...............................1


Where is the macula?..................................................................1


Are there different forms of AMD?...............................................2


What is wet AMD?.......................................................................2


What is dry AMD? .......................................................................2


Do drusen cause vision loss in advanced dry AMD?..................4


The dry form has early and intermediate stages.


Does the wet form have similar stages? .....................................5


Can advanced AMD be either the dry or the wet form?..............5


Which is more common—the dry form or the wet form? ............5


Can the dry form turn into the wet form? ....................................6


Who is at risk for AMD?...............................................................6


How is AMD detected?................................................................7


How is dry AMD treated? ............................................................8


What is the dosage of the AREDS formulation? .........................8


Who should take the AREDS formulation? .................................9


Can people with early stage AMD take the AREDS 


formulation to help prevent the disease from 


progressing to the intermediate stage?.......................................9

Can diet alone provide the same high levels of 


antioxidants and zinc as the AREDS formulation?....................10


Can a daily multivitamin alone provide the 


same high levels of antioxidants and zinc 


as the AREDS formulation?.......................................................10


How is wet AMD treated?..........................................................10


What can I do if I already have lost some 


vision from AMD? ......................................................................12


What research is being done?...................................................12


What can I do to protect my vision?..........................................13


Can my lifestyle make a difference?..........................................15


What should I ask my eye care professional?...........................16


Where can I get more information?...........................................19

What is age-related macular 

degeneration? 

Age-related macular degeneration (AMD) is a disease that 

blurs the sharp, central vision you need for “straight-ahead” 

activities such as reading, sewing, and driving. AMD affects the 

macula, the part of the eye that allows you to see fine detail. 

(See diagram below.) AMD causes no pain. 

In some cases, AMD advances so slowly that people notice little 

change in their vision. In others, the disease progresses faster 

and may lead to a loss of vision in both eyes. AMD is a leading 

cause of vision loss in Americans 60 years of age and older. 

Where is the macula? 

The macula is located in the center of the retina, the lightsensitive tissue at the back of the eye. The retina instantly 

1

converts light, or an image, into electrical impulses. The retina 

then sends these impulses, or nerve signals, to the brain. 

Are there different forms of AMD? 

AMD occurs in two forms: wet and dry. 

What is wet AMD? 

Wet AMD occurs when abnormal blood vessels behind the retina 

start to grow under the macula. These new blood vessels tend to 

be very fragile and often leak blood and fluid. The blood and fluid 

raise the macula from its normal place at the back of the eye. 

Damage to the macula occurs rapidly. 

With wet AMD, loss of central vision can occur quickly. Wet AMD 

is considered to be advanced AMD and is more severe than the 

dry form. 

An early symptom of wet AMD is that straight lines appear wavy. 

If you notice this condition or other changes to your vision, 

contact your eye care professional at once. You need a 

comprehensive dilated eye exam. 

What is dry AMD? 

Dry AMD occurs when the light-sensitive cells in the macula 

slowly break down, gradually blurring central vision in the 

affected eye. As dry AMD gets worse, you may see a blurred 

spot in the center of your vision. Over time, as less of the macula 

functions, central vision in the affected eye can be lost gradually. 

2 
Normal vision The same scene as viewed by 

a person with age-related 

macular degeneration 

The most common symptom of dry AMD is slightly blurred vision. 

You may have difficulty recognizing faces. You may need more 

light for reading and other tasks. Dry AMD generally affects both 

eyes, but vision can be lost in one eye while the other eye seems 

unaffected. 

One of the most common early signs of dry AMD is drusen. 

Drusen are yellow deposits under the retina. They often are 

found in people over age 60. Your eye care professional can 

detect drusen during a comprehensive dilated eye exam. 

Dry AMD has three stages, all of which may occur in one or both 

eyes: 

1. Early AMD. People with early AMD have either several small 

drusen or a few medium-sized drusen. At this stage, there are 

no symptoms and no vision loss. 

3

2. Intermediate AMD. People with intermediate AMD have 

either many medium-sized drusen or one or more large 

drusen. Some people see a blurred spot in the center of their 

vision. More light may be needed for reading and other tasks. 

3. Advanced Dry AMD. In addition to drusen, people with 

advanced dry AMD have a breakdown of light-sensitive cells 

and supporting tissue in the central retinal area. This 

breakdown can cause a blurred spot in the center of your 

vision. Over time, the blurred spot may get bigger and darker, 

taking more of your central vision. You may have difficulty 

reading or recognizing faces until they are very close to you. 

If you have vision loss from dry AMD in one eye only, you may 

not notice any changes in your overall vision. With the other eye 

seeing clearly, you still can drive, read, and see fine details. You 

may notice changes in your vision only if AMD affects both eyes. 

If blurriness occurs in your vision, see an eye care professional 

for a comprehensive dilated eye exam. 

Do drusen cause vision loss 

in advanced dry AMD? 

Drusen alone do not usually cause vision loss. In fact, scientists 

are unclear about the connection between drusen and AMD. 

They do know that an increase in the size or number of drusen 

raises a person's risk of developing either advanced dry AMD or 

wet AMD. These changes can cause serious vision loss. 

4

The dry form has early and intermediate 

stages. Does the wet form have similar 

stages? 

No. The wet form is considered advanced AMD. 

Can advanced AMD be either the dry 

form or the wet form? 

Yes. Both the wet form and the advanced dry form are 

considered advanced AMD. Vision loss occurs with either form. In 

most cases, only advanced AMD can cause vision loss. 

People who have advanced AMD in one eye are at especially 

high risk of developing advanced AMD in the other eye. 

Which is more common—the dry form 

or the wet form? 

The dry form is much more common. More than 85 percent of all 

people with intermediate and advanced AMD combined have the 

dry form. 

However, if only advanced AMD is considered, about two-thirds 

of patients have the wet form. Because almost all vision loss 

comes from advanced AMD, the wet form leads to significantly 

more vision loss than the dry form. 

5

Can the dry form turn into the wet 

form? 

Yes. All people who have the wet form had the dry form first. 

The dry form can advance and cause vision loss without turning 

into the wet form. The dry form also can suddenly turn into the 

wet form, even during early stage AMD. There is no way to tell if 

or when the dry form will turn into the wet form. 

Who is at risk for AMD? 

AMD can occur during middle age. The risk increases with aging. 

Other risk factors include: 

• Smoking. 

•	 Obesity. Research studies suggest a link between obesity and 

the progression of early and intermediate stage AMD to 

advanced AMD. 

•	 Race. Whites are much more likely to lose vision from AMD 

than African Americans. 

•	 Family history. People with a family history of AMD are at 

higher risk of getting the disease. 

• Gender. Women appear to be at greater risk than men. 

6

How is AMD detected? 

AMD is detected during a comprehensive eye exam that 

includes: 

•	 Visual acuity test. This eye chart test measures how well 

you see at various distances. 

•	 Dilated eye exam. Drops are placed in your eyes to widen, 

or dilate, the pupils. Your eye care professional uses a special 

magnifying lens to examine your retina and optic nerve for 

signs of AMD and other eye problems. After the exam, your 

close-up vision may remain blurred for several hours. 

•	 Tonometry. An instrument measures the pressure inside the 

eye. Numbing drops may be applied to your eye for this test. 

Your eye care professional also may do other tests to learn more 

about the structure and health of your eye. 

During an eye exam, you may be asked to look at an Amsler 

grid. The pattern of the grid resembles a checkerboard. You will 

cover one eye and stare at a black dot in the center of the grid. 

While staring at the dot, you may notice that the straight lines in 

the pattern appear wavy. You may notice that some of the lines 

are missing. These may be signs of AMD. (See Amsler grid on 

page 14.) 

If your eye care professional believes you need treatment for wet 

AMD, he or she may suggest a fluorescein angiogram. In this 

test, a special dye is injected into your arm. Pictures are taken as 

the dye passes through the blood vessels in your retina. The test 

7 
allows your eye care professional to identify any leaking blood 

vessels and recommend treatment. 

How is dry AMD treated? 

Once dry AMD reaches the advanced stage, no form of 

treatment can prevent vision loss. However, treatment can delay 

and possibly prevent intermediate AMD from progressing to the 

advanced stage, in which vision loss occurs. The National Eye 

Institute’s Age-Related Eye Disease Study (AREDS) found that 

taking a specific high-dose formulation of antioxidants and zinc 

significantly reduces the risk of advanced AMD and its 

associated vision loss. Slowing AMD's progression from the 

intermediate stage to the advanced stage will save the vision of 

many people. 

What is the dosage of the AREDS 

formulation? 

The specific daily amounts of antioxidants and zinc used by the 

study researchers were 500 milligrams of vitamin C, 400 

International Units of vitamin E, 15 milligrams of beta-carotene 

(often labeled as equivalent to 25,000 International Units of 

vitamin A), 80 milligrams of zinc as zinc oxide, and two 

milligrams of copper as cupric oxide. Copper was added to the 

AREDS formulation containing zinc to prevent copper deficiency 

anemia, a condition associated with high levels of zinc intake. 

8

Who should take the AREDS formulation? 

People who are at high risk for developing advanced AMD should 

consider taking the formulation. You are at high risk for 

developing advanced AMD if you have either: 

1. Intermediate AMD in one or both eyes. 

OR 

2. Advanced AMD (dry or wet) in one eye but not the other eye. 

Your eye care professional can tell you if you have AMD, its 

stage, and your risk for developing the advanced form. 

The AREDS formulation is not a cure for AMD. It will not restore 

vision already lost from the disease. However, it may delay the 

onset of advanced AMD. It may help people who are at high risk 

for developing advanced AMD keep their vision. 

Can people with early stage AMD take 

the AREDS formulation to help prevent 

the disease from progressing to the 

intermediate stage? 

There is no apparent need for those diagnosed with early stage 

AMD to take the AREDS formulation. The study did not find that 

the formulation provided a benefit to those with early stage AMD. 

If you have early stage AMD, a comprehensive dilated eye exam 

every year can help determine if the disease is progressing. If 

early stage AMD progresses to the intermediate stage, discuss 

taking the formulation with your doctor. 

9 
Can diet alone provide the same high 

levels of antioxidants and zinc as the 

AREDS formulation? 

No. The high levels of vitamins and minerals are difficult to achieve 

from diet alone. However, previous studies have suggested that 

people who have diets rich in green leafy vegetables have a lower 

risk of developing AMD. 

Can a daily multivitamin alone provide 

the same high levels of antioxidants


and zinc as the AREDS formulation?


No. The formulation's levels of antioxidants and zinc are 

considerably higher than the amounts in any daily multivitamin. 

If you are already taking daily multivitamins and your doctor 

suggests you take the high-dose AREDS formulation, be sure to 

review all your vitamin supplements with your doctor before you 

begin. Because multivitamins contain many important vitamins 

not found in the AREDS formulation, you may want to take a 

multivitamin along with the AREDS formulation. For example, 

people with osteoporosis need to be particularly concerned 

about taking vitamin D, which is not in the AREDS formulation. 

How is wet AMD treated? 

There are two treatments for wet AMD: laser surgery and 

photodynamic therapy. Neither treatment is a cure for wet 

AMD. Each treatment may slow the rate of vision decline or stop 

further vision loss. The disease and loss of vision may progress 

despite treatment. 

10 
•	 Laser surgery. This procedure uses a laser to destroy the 

fragile, leaky blood vessels. A high energy beam of light is 

aimed directly onto the new blood vessels and destroys them, 

preventing further loss of vision. However, laser treatment also 

may destroy some surrounding healthy tissue and some 

vision. Only a small percentage of people with wet AMD can 

be treated with laser surgery. Laser surgery is more effective if 

the leaky blood vessels have developed away from the fovea, 

the central part of the macula. (See diagram on page 1.) Laser 

surgery is performed in a doctor's office or eye clinic. 

The risk of new blood vessels developing after laser treatment 

is high. Repeated treatments may be necessary. In some 

cases, vision loss may progress despite repeated treatments. 

•	 Photodynamic therapy. A drug called verteporfin is injected 

into your arm. It travels throughout the body, including the new 

blood vessels in your eye. The drug tends to “stick” to the 

surface of new blood vessels. Next, a light is shined into your 

eye for about 90 seconds. The light activates the drug. The 

activated drug destroys the new blood vessels and leads to a 

slower rate of vision decline. Unlike laser surgery, this drug 

does not destroy surrounding healthy tissue. Because the drug 

is activated by light, you must avoid exposing your skin or eyes 

to direct sunlight or bright indoor light for five days after 

treatment. Photodynamic therapy is relatively painless. It takes 

about 20 minutes and can be performed in a doctor's office. 

Photodynamic therapy slows the rate of vision loss. It does not 

stop vision loss or restore vision in eyes already damaged by 

11 
advanced AMD. Treatment results often are temporary. You 

may need to be treated again. 

What can I do if I already have lost 

some vision from AMD? 

If you have lost some sight from AMD, don't be afraid to use your 

eyes for reading, watching TV, and other routine activities. 

Normal use of your eyes will not cause further damage to your 

vision. 

If you have lost some sight from AMD, ask your eye care 

professional about low vision services and devices that may help 

you make the most of your remaining vision. Ask for a referral to 

a specialist in low vision. Many community organizations and 

agencies offer information about low vision counseling, training, 

and other special services for people with visual impairments. A 

nearby school of medicine or optometry may provide low vision 

services. 

What research is being done? 

The National Eye Institute is conducting and supporting a 

number of studies to learn more about AMD. 

For example, scientists are: 

•	 Studying the possibility of transplanting healthy cells into a 

diseased retina. 

•	 Evaluating families with a history of AMD to understand 

genetic and hereditary factors that may cause the disease. 

12 
•	 Looking at certain anti-inflammatory treatments for the wet 

form of AMD. 

This research should provide better ways to detect, treat, and 

prevent vision loss in people with AMD. 

What can I do to protect my vision? 

•	 Dry AMD. If you have dry AMD, you should have a 

comprehensive dilated eye exam at least once a year. Your eye 

care professional can monitor your condition and check for 

other eye diseases. Also, if you have intermediate AMD in one 

or both eyes, or advanced AMD in one eye only, your doctor 

may suggest that you take the AREDS formulation containing 

the high levels of antioxidants and zinc. 

Because dry AMD can turn into wet AMD at any time, you 

should get an Amsler grid from your eye care professional or 

use the one on page 14. Use the grid every day to evaluate 

your vision for signs of wet AMD. This quick test works best for 

people who still have good central vision. Check each eye 

separately. Cover one eye and look at the grid. Then cover 

your other eye and look at the grid. If you detect any changes 

in the appearance of this grid or in your everyday vision while 

reading the newspaper or watching television, get a 

comprehensive dilated eye exam. 

•	 Wet AMD. If you have wet AMD and your doctor advises 

treatment, do not wait. After laser surgery or photodynamic 

therapy, you will need frequent eye exams to detect any 

recurrence of leaking blood vessels. Studies show that people 

13 
Here is what an Amsler grid normally looks like.


This is what an Amsler grid might look to someone with AMD.


14

who smoke have a greater risk of recurrence than those 


who don't.


In addition, check your vision at home with the Amsler grid.


If you detect any changes, schedule an eye exam immediately.


Can my lifestyle make a difference? 

Your lifestyle can play a role in reducing your risk of developing 

AMD. 

• Eat a healthy diet high in green leafy vegetables and fish. 

• Don’t smoke. 

• Maintain normal blood pressure. 

• Watch your weight. 

• Exercise. 

15

What should I ask my eye care 

professional? 

You can protect yourself against vision loss by working in 

partnership with your eye care professional. Ask questions and get 

the information you need to take care of yourself and your family. 

What are some questions to ask? 

About my eye disease or disorder... 

• What is my diagnosis? 

• What caused my condition? 

• Can my condition be treated? 

• How will this condition affect my vision now and in the future? 

•	 Should I watch for any particular symptoms and notify you if 

they occur? 

• Should I make any lifestyle changes? 

About my treatment... 

• What is the treatment for my condition? 

• When will the treatment start and how long will it last? 

•	 What are the benefits of this treatment and how successful 

is it? 

•	 What are the risks and side effects associated with this 

treatment? 

16 
•	 Are there foods, drugs, or activities I should avoid while I’m on 

this treatment? 

•	 If my treatment includes taking medicine, what should I do if I 

miss a dose? 

• Are other treatments available? 

About my tests... 

• What kinds of tests will I have? 

• What can I expect to find out from these tests? 

• When will I know the results? 

•	 Do I have to do anything special to prepare for any of the 

tests? 

• Do these tests have any side effects or risks? 

• Will I need more tests later? 

Other suggestions 

•	 If you don't understand your eye care professional’s 

responses, ask questions until you do understand. 

•	 Take notes or get a friend or family member to take notes for 

you. Or, bring a tape recorder to help you remember the 

discussion. 

•	 Ask your eye care professional to write down his or her 

instructions to you. 

17

•	 Ask your eye care professional for printed material about your 

condition. 

•	 If you still have trouble understanding your eye care 

professional's answers, ask where you can go for more 

information. 

•	 Other members of your health care team, such as nurses and 

pharmacists, can be good sources of information. Talk to them, 

too. 

Today, patients take an active role in their health care. Be an 

active patient about your eye care. 

18

Where can I get more information?


For more information about age-related macular 

degeneration, you may wish to contact: 

American Academy of Ophthalmology* 

P.O. Box 7424


San Francisco, CA 94120–7424


415–561–8500


www.aao.org


American Optometric Association* 

243 North Lindbergh Boulevard


St. Louis, MO 63141–7851


314–991–4100


www.aoa.org


Association for Macular Diseases 

210 East 64th Street, 8th Floor 

New York, NY 10021–7471 

212–605–3719 

www.macular.org 

Foundation Fighting Blindness 

Executive Plaza 1, Suite 800 

11350 McCormick Road 

Hunt Valley, MD 21031–1014 

1–800–683–5555 

410–785–1414 

www.blindness.org 

19

Macular Degeneration Partnership 

8733 Beverly Boulevard, Suite 201


Los Angeles, CA 90048–1844


1–888–430–9898


310–423–6455


www.amd.org


National Eye Institute* 

National Institutes of Health 

2020 Vision Place 

Bethesda, MD 20892–3655 

301–496–5248 

E-mail: 2020@nei.nih.gov 

www.nei.nih.gov 

Prevent Blindness America 

500 East Remington Road


Schaumburg, IL 60173–4557


1–800–331–2020


847–843–2020


E-mail: info@preventblindness.org


www.preventblindness.org


*These organizations also provide information on low vision.


20

For more information about low vision services and 

programs, you may wish to contact: 

American Foundation for the Blind 

11 Penn Plaza, Suite 300 

New York, NY 10011–2006 

1–800–232–5463 

212–502–7600 

E-mail: afbinfo@afb.net 

www.afb.org 

Council of Citizens with Low Vision International 

1–800–733–2258 

Lighthouse International 

111 East 59th Street 

New York, NY 10022–1202 

1–800–334–5497 

1–800–829–0500 

212–821–9200 

212–821–9713 (TDD) 

E-mail: info@lighthouse.org 

www.lighthouse.org 

National Association for Visually Handicapped 

22 West 21st Street, 6th Floor


New York, NY 10010–6493


212–889–3141


www.navh.org 


21

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

National Institutes of Health 

National Eye Institute 

NIH Publication No: 

Revised 9/03 

03-2294