Age-Related 

Macular Degeneration

What You Should Know

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Eye Institute
B

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. NEI is 

part of the National Institutes of Health, an agency of the 

U.S. Department of Health and Human Services. 

For more information, contact—

National Eye Institute 

National Institutes of Health

2020 Vision Place

Bethesda, MD 20892–3655

Telephone: 301–496–5248

Email: 2020@nei.nih.gov

Website: www.nei.nih.gov
Contents

About AMD 1

Detection 4

Stages of AMD 7

Treatment 9

What You Can Do 14

Current Research 21

Additional Resources 23

1

About AMD

What is AMD?

AMD is a common eye condition and a leading cause 

of vision loss among people age 60 and older. It causes 

damage to the macula, a small spot near the center of the 

retina and the part of the eye needed for sharp, central 

vision, which lets us see objects that are straight ahead.

In some people, AMD advances so slowly that vision loss 

does not occur for a long time. In others, the disease 

progresses faster and may lead to a loss of vision in one 

or both eyes. As AMD progresses, a blurred area near the 

center of vision is a common symptom. Over time, the 

blurred area may grow larger or you may develop blank 

spots in your central vision. Objects also may not appear to 

be as bright as they used to be. 

AMD by itself does not lead to complete blindness, with no 

ability to see. However, the loss of central vision in AMD 

can interfere with simple everyday activities, such as the 

ability to see faces, drive, read, write, or do close work, such 

as cooking or fixing things around the house.
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The macula

The macula is made 

up of millions of 

light-sensing cells 

that provide sharp, 

central vision. It is 

the most sensitive 

part of the retina, 

which is located 

at the back of the eye. The retina turns light into 

electrical signals and then sends these electrical signals 

through the optic nerve to the brain, where they are 

translated into the images we see. When the macula is 

damaged, the center of your field of view may appear 

blurry, distorted, or dark.

 

Who is at risk?

Age is a major risk factor for AMD. The disease is most likely 

to occur after age 60, but it can occur earlier. Other risk 

factors for AMD include:

• Smoking. Research shows that smoking doubles the risk 

of AMD.

• Race. AMD is more common among Caucasians than 

among African-Americans or Hispanics/Latinos.

• Family history and genetics. People with a family history 

of AMD are at higher risk. At last count, researchers had 

identified nearly 20 genes that can affect the risk of developing 

AMD. Many more genetic risk factors are suspected.
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About AMD

 You may see offers for genetic testing for AMD. Because 

AMD is influenced by so many genes, plus environmental 

factors such as smoking and nutrition, there are currently 

no genetic tests that can diagnose AMD, or predict with 

certainty who will develop it.

The American Academy of Ophthalmology currently 

recommends against routine genetic testing for AMD, 

and insurance generally does not cover such testing.

Does lifestyle make a difference?

Researchers have found links between AMD and some 

lifestyle choices, such as smoking. You might be able 

to reduce your risk of AMD or slow its progression by 

making these healthy choices:

• Avoid smoking

• Exercise regularly

• Maintain normal blood pressure and 

cholesterol levels

• Eat a healthy diet rich in green, leafy 

vegetables and fish
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How is AMD detected?

The early and intermediate stages of AMD usually start 

without symptoms. Only a comprehensive dilated eye exam 

can detect AMD. The eye exam may include the following:

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

see at distances.

• Dilated eye exam. Your eye care professional places drops 

in your eyes to widen or dilate the pupils. This provides 

a better view of the back of your eye. Using a special 

magnifying lens, he or she then looks at your retina and 

optic nerve for signs of AMD and other eye problems.

• Amsler grid. Your eye care professional also may ask you 

to look at an Amsler grid. Changes in your central vision 

may cause the lines in the grid to disappear or appear 

wavy, a sign of AMD.

• Fluorescein angiogram. In this test, which is performed 

by an ophthalmologist, a fluorescent dye is injected into 

your arm. Pictures are taken as the dye passes through 

This is what an Amsler grid 

might look like to someone 

with AMD.

Here is what an Amsler grid 

normally looks like.
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Detection

the blood vessels in your eye. This makes it possible to 

see leaking blood vessels, which occur in a severe, rapidly 

progressive type of AMD (see page 8). In rare cases, 

complications to the injection can arise, from nausea to 

more severe allergic reactions.

• Optical coherence tomography. You have probably heard 

of ultrasound, which uses sound waves to capture images 

of living tissues. OCT is similar except that it uses light 

waves, and can achieve very high-resolution images of 

any tissues that can be penetrated by light—such as the 

eyes. After your eyes are dilated, you’ll be asked to place 

your head on a chin rest and hold still for several seconds 

while the images are obtained. The light beam is painless.

During the exam, your eye care professional will look for 

drusen, which are yellow deposits beneath the retina. 

Most people develop some very small drusen as a normal 

part of aging. The presence of medium-to-large drusen 

may indicate that you have AMD.

Another sign of AMD is the appearance of pigmentary 

changes under the retina. In addition to the pigmented cells 

in the iris (the colored part of the eye), there are pigmented 

cells beneath the retina. As these cells break down and 

release their pigment, your eye care professional may see 

dark clumps of released pigment and later, areas that are 

less pigmented. These changes will not affect your eye color.
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Questions to ask your eye care 

professional

Below are a few questions you may want to ask your 

eye care professional to help you understand your 

diagnosis and treatment. If you do not understand 

your eye care professional’s responses, ask questions 

until you do understand.

• What is my diagnosis and how do you spell the name 

of the condition?

• Can my AMD be treated?

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

future?

• What symptoms should I watch for and how should I 

notify you if they occur?

• Should I make lifestyle changes?
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What are the stages of AMD?

There are three stages of AMD defined in part by the size 

and number of drusen under the retina. It is possible to 

have AMD in one eye only, or to have one eye with a later 

stage of AMD than the other.

• Early AMD. Early AMD is diagnosed by the presence of 

medium-sized drusen, which are about the width of an 

average human hair. People with early AMD typically do 

not have vision loss. 

• Intermediate AMD. People with intermediate AMD 

typically have large drusen, pigment changes in the 

retina, or both. Again, these changes can only be 

detected during an eye exam. Intermediate AMD 

may cause some vision loss, but most people will not 

experience any symptoms.

• Late AMD. In addition to drusen, people with late AMD 

have vision loss from damage to the macula. There are 

two types of late AMD:

• In geographic atrophy (also called dry AMD), there is 

a gradual breakdown of the light-sensitive cells in the 

macula that convey visual information to the brain, 

and of the supporting tissue beneath the macula. 

These changes cause vision loss.

Stages of AMD
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• In neovascular AMD (also called wet AMD), 

abnormal blood vessels grow underneath the retina. 

(“Neovascular” literally means “new vessels.”) These 

vessels can leak fluid and blood, which may lead to 

swelling and damage of the macula. The damage may 

be rapid and severe, unlike the more gradual course 

of geographic atrophy. It is possible to have both 

geographic atrophy and neovascular AMD in the same 

eye, and either condition can appear first.

AMD has few symptoms in the early stages, so it is important 

to have your eyes examined regularly. If you are at risk for AMD 

because of age, family history, lifestyle, or some combination 

of these factors, you should not wait to experience changes 

in vision before getting checked for AMD.

Not everyone with early AMD will develop late AMD. For 

people who have early AMD in one eye and no signs of 

AMD in the other eye, about five percent will develop 

advanced AMD after 10 years. For people who have early 

AMD in both eyes, about 14 percent will develop late AMD 

in at least one eye after 10 years. With prompt detection of 

AMD, there are steps you can take to further reduce your 

risk of vision loss from late AMD.

If you have late AMD in one eye only, you may not notice 

any changes in your overall vision. With the other eye seeing 

clearly, you may still be able to drive, read, and see fine 

details. However, having late AMD in one eye means you are 

at increased risk for late AMD in your other eye. If you notice 

distortion or blurred vision, even if it doesn’t have much 

effect on your daily life, consult an eye care professional.
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How is AMD treated?

Early AMD

Currently, no treatment exists for early AMD, which in many 

people shows no symptoms or loss of vision. Your eye care 

professional may recommend that you get a comprehensive 

dilated eye exam at least once a year. The exam will help 

determine if your condition is advancing.

As for prevention, AMD occurs less often in people who 

exercise, avoid smoking, and eat nutritious foods including 

green leafy vegetables and fish. If you already have AMD, 

adopting some of these habits may help you keep your 

vision longer.

Intermediate and late AMD

Researchers at the National Eye Institute tested whether 

taking nutritional supplements could protect against 

AMD in the Age-Related Eye Disease Studies (AREDS and 

AREDS2). They found that daily intake of certain high-dose 

vitamins and minerals can slow progression of the disease in 

people who have intermediate AMD, and those who have 

late AMD in one eye.

The first AREDS trial showed that a combination of vitamin 

C, vitamin E, beta-carotene, zinc, and copper can reduce 

the risk of late AMD by 25 percent. The AREDS2 trial tested 

whether this formulation could be improved by adding 

Treatment 
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lutein, zeaxanthin or omega-3 fatty acids. Omega-3 fatty 

acids are nutrients enriched in fish oils. Lutein, zeaxanthin 

and beta-carotene all belong to the same family of 

vitamins, and are abundant in green leafy vegetables.

The AREDS2 trial found that adding lutein and zeaxanthin 

or omega-3 fatty acids to the original AREDS formulation 

(with beta-carotene) had no overall effect on the risk of late 

AMD. However, the trial also found that replacing betacarotene with a 5-to-1 mixture of lutein and zeaxanthin 

may help further reduce the risk of late AMD. Moreover, 

while beta-carotene has been linked to an increased risk 

of lung cancer in current and former smokers, lutein and 

zeaxanthin appear to be safe regardless of smoking status. 

Here are the clinically effective doses tested in AREDS and 

AREDS2:

• 500 milligrams (mg) of vitamin C

• 400 international units of vitamin E

• 80 mg zinc as zinc oxide (25 mg in AREDS2)

• 2 mg copper as cupric oxide

• 15 mg beta-carotene, OR 10 mg lutein and 2 mg 

zeaxanthin

A number of manufacturers offer nutritional supplements 

that were formulated based on these studies. The label may 

refer to “AREDS” or “AREDS2.”
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Treatment 

If you have intermediate or late AMD, you might benefit 

from taking such supplements. But first, be sure to review 

and compare the labels. Many of the supplements have 

different ingredients, or different doses, from those tested 

in the AREDS trials. Also, consult your doctor or eye care 

professional about which supplement, if any, is right for 

you. For example, if you smoke regularly, or used to, 

your doctor may recommend that you avoid supplements 

containing beta-carotene.

Even if you take a daily multivitamin, you should consider 

taking an AREDS supplement if you are at risk for late AMD. 

The formulations tested in the AREDS trials contain much 

higher doses of vitamins and minerals than what is found 

in multivitamins. Tell your doctor or eye care professional 

about any multivitamins you are taking when you are 

discussing possible AREDS formulations.

You may see claims that your specific genetic makeup 

(genotype) can influence how you will respond to AREDS 

supplements. Some recent studies have claimed that, 

depending on genotype, some patients will benefit from 

AREDS supplements and others could be harmed. These 

claims are based on a portion of data from the AREDS 

research. NEI investigators have done comprehensive 

analyses of the complete AREDS data. Their findings to date 

indicate that AREDS supplements are beneficial for patients 

of all tested genotypes. Based on the overall data, the 
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American Academy of Ophthalmology does not support the 

use of genetic testing to guide treatment for AMD.

Finally, remember that the AREDS formulation is not a 

cure. It does not help people with early AMD, and will 

not restore vision already lost from AMD. But it may delay 

the onset of late AMD. It also may help slow vision loss in 

people who already have late AMD. 

Advanced neovascular AMD

Neovascular AMD typically results in severe vision loss. 

However, eye care professionals can try different therapies 

to stop further vision loss. You should remember that the 

therapies described below are not a cure. The condition 

may progress even with treatment.

• Injections. One option to slow the progression of 

neovascular AMD is to inject drugs into the eye. With 

neovascular AMD, abnormally high levels of vascular 

endothelial growth factor (VEGF) are secreted in your 

eyes. VEGF is a protein that promotes the growth of new 

abnormal blood vessels. Anti-VEGF injection therapy 

blocks this growth. If you get this treatment, you may 

need multiple monthly injections. Before each injection, 

your eye will be numbed and cleaned with antiseptics. 

To further reduce the risk of infection, you may be 

prescribed antibiotic drops. A few different anti-VEGF 

drugs are available. They vary in cost and in how often 

they need to be injected, so you may wish to discuss these 

issues with your eye care professional.
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Treatment 

• Photodynamic therapy. This technique involves laser 

treatment of select areas of the retina. First, a drug called 

verteporfin will be injected into a vein in your arm. The 

drug travels through the blood vessels in your body, and 

is absorbed by new, growing blood vessels. Your eye care 

professional then shines a laser beam into your eye to 

activate the drug in the new abnormal blood vessels, while 

sparing normal ones. Once activated, the drug closes off 

the new blood vessels, slows their growth, and slows the 

rate of vision loss. This procedure is less common than antiVEGF injections, and is often used in combination with 

them for specific types of neovascular AMD.

• Laser surgery. Eye care professionals treat certain cases 

of neovascular AMD with laser surgery, though this is less 

common than other treatments. It involves aiming an 

intense “hot” laser at the abnormal blood vessels in your 

eyes to destroy them. This laser is not the same one used 

in photodynamic therapy which may be referred to as a 

“cold” laser. This treatment is more likely to be used when 

blood vessel growth is limited to a compact area in your 

eye, away from the center of the macula, that can be easily 

targeted with the laser. Even so, laser treatment also may 

destroy some surrounding healthy tissue. This often results 

in a small blind spot where the laser has scarred the retina. 

In some cases, vision immediately after the surgery may be 

worse than it was before. But the surgery may also help 

prevent more severe vision loss from occurring years later.
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How can I cope with vision loss?

Coping with AMD and vision loss can be a traumatic 

experience. This is especially true if you have just begun to lose 

your vision or have low vision. Having low vision means that 

even with regular glasses, contact lenses, medicine, or surgery, 

you find everyday tasks difficult to do. Reading the mail, 

shopping, cooking, and writing can all seem challenging.

However, help is available. You may not be able to restore 

your vision, but low vision services can help you make the 

most of what is remaining. You can continue enjoying 

friends, family, hobbies, and other interests just as you 

always have. The key is to not delay use of these services.

Questions to ask your eye care 

professional about treatment 

• What is the treatment for advanced 

neovascular AMD? 

• When will 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 and how has this 

information been gathered? 

• Should I avoid certain foods, drugs, or activities 

while I am undergoing treatment? 

• Are other treatments available? 

• When should I follow up after treatment? 
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What is vision rehabilitation?

To cope with vision loss, you must first have an excellent 

support team. This team should include you, your primary 

eye care professional, and an optometrist or ophthalmologist 

specializing in low vision. Occupational therapists, orientation 

and mobility specialists, certified low vision therapists, 

counselors, and social workers are also available to help. 

Together, the low vision team can help you make the most 

of your remaining vision and maintain your independence.

Second, talk with your eye care professional about your 

vision problems. Ask about vision rehabilitation, even if 

your eye care professional says that “nothing more can be 

done for your vision.” Vision rehabilitation programs offer 

a wide range of services, including training for magnifying 

and adaptive devices, ways to complete daily living skills 

safely and independently, guidance on modifying your 

home, and information on where to locate resources and 

support to help you cope with your vision loss.

Medicare may cover part or all of a patient’s occupational 

therapy, but the therapy must be ordered by a doctor and 

provided by a Medicare-approved healthcare provider. To 

see if you are eligible for Medicare-funded occupational 

therapy, call 1–800–MEDICARE or 1–800–633–4227.

What You Can Do
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Where can I go for services?

Low vision services can take place in different locations, 

including:

• Ophthalmology or optometry offices that specialize in 

low vision

• Hospital clinics

• State, nonprofit, or for-profit vision rehabilitation 

organizations

• Independent-living centers

What are some low vision devices?

Because low vision varies from person to person, specialists 

have different tools to help patients deal with vision loss. 

They include:

• Reading glasses with high-powered lenses

• Handheld magnifiers

• Video magnifiers

• Computers with large-print and speech-output systems

• Large-print reading materials

• Talking watches, clocks, and calculators

• Computer aids and other technologies, such as a closedcircuit television, which uses a camera and television to 

enlarge printed text
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For some patients with end-stage AMD, an Implantable 

Miniature Telescope (IMT) may be an option. This FDAapproved device can help restore some lost vision by 

refocusing images onto a healthier part of the retina. After 

the surgery to implant the IMT, patients participate in an 

extensive vision rehabilitation program. 

Keep in mind that low vision aids without proper diagnosis, 

evaluation, and training may not work for you. It is 

important that you work closely with your low vision 

team to get the best device or combination of aids to help 

improve your ability to see.

What You Can Do

Questions to ask your eye care 

professional about low vision

• How can I continue my normal, routine 

activities?

• Are there resources to help me?

• Will any special devices help me with reading, 

cooking, or fixing things around the house?

• What training is available to me?

• Where can I find individual or group support to 

cope with my vision loss?
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What is Charles Bonnet syndrome (visual hallucinations)?

People with impaired vision sometimes see things that are 

not there, called visual hallucinations. They may see simple 

patterns of colors or shapes, or detailed pictures of people, 

animals, buildings, or landscapes. Sometimes these images 

fit logically into a visual scene, but they often do not. 

This condition can be alarming, but don’t worry—it is not a 

sign of mental illness. It is called Charles Bonnet syndrome, 

and it is similar to what happens to some people who have 

lost an arm or leg. Even though the limb is gone, these 

people still feel their toes or fingers or experience itching. 

Similarly, when the brain loses input from the eyes, it may 

fill the void by generating visual images on its own.

Charles Bonnet syndrome is a common side effect of vision 

loss in people with AMD. However, it often goes away a 

year to 18 months after it begins. In the meantime, there 

are things you can do to reduce hallucinations. Many 

people find the hallucinations occur more frequently in 

evening or dim light. Turning on a light or television may 

help. It may also help to blink, close your eyes, or focus on a 

real object for a few moments.

How can I cope with AMD?

AMD and vision loss can profoundly affect your life. This is 

especially true if you lose your vision rapidly.

Even if you experience gradual vision loss, you may not be 

able to live your life the way you used to. You may need 

to cut back on working, volunteering, and recreational 
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activities. Your relationships may change, and you may 

need more help from family and friends than you are used 

to. These changes can lead to feelings of loss, lowered selfesteem, isolation, and depression.

In addition to getting medical treatment for AMD, there 

are things you can do to cope:

• Learn more about your vision loss.

• Visit a specialist in low vision and get devices and learning 

skills to help you with the tasks of everyday living.

• Try to stay positive. People who remain hopeful say they 

are better able to cope with AMD and vision loss.

• Stay engaged with family and friends.

• Seek a professional counselor or support group. Your 

doctor or eye care professional may be able to refer you 

to one.

What information can I share with family members?

Shock, disbelief, depression, and anger are common 

reactions among people who are diagnosed with AMD. 

These feelings can subside after a few days or weeks, 

or they may last longer. This can be upsetting to family 

members and caregivers who are trying to be as caring and 

supportive as possible.

What You Can Do
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Following are some ideas family members might consider:

• Obtain as much information as possible about AMD and 

how it affects sight. Share the information with the 

person who has AMD.

• Find support groups and other resources within the 

community.

• Encourage family and friends to visit and support the 

person with AMD.

• Allow for grieving. This is a natural process.

• Lend support by “being there.”
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What research is being done?

NEI conducts and supports research in labs and clinical centers 

across the country to better prevent, detect, and treat AMD. 

NEI-funded research over the past decade has revealed new 

insight into the genetics of AMD. By screening the DNA 

of thousands of people with and without AMD, scientists 

have identified differences in genes that affect AMD risk. 

Armed with this knowledge, researchers are identifying 

key biochemical pathways involved in the disease and are 

exploring therapies that could interrupt these pathways. It 

might also be possible to develop drug therapies for AMD 

that are targeted specifically to a person’s unique genetic 

risk factors. 

Scientists are also exploring ways to regenerate tissues 

destroyed by AMD. One approach is to make stem cells 

from a patient’s own skin or blood. In a lab, these stem cells 

can be specially treated to form sheets of retinal pigment 

epithelium (RPE)—the pigmented layer of tissue that 

supports the light-sensitive cells of the retina. The goal is 

to generate layers of RPE that can be implanted into the 

patient’s eye to preserve vision. 

The NEI Audacious Goals Initiative (AGI) is taking on one 

of the biggest challenges in medicine: the regeneration of 

nerve cells in the retina and brain. In humans, once brain 

and retinal neurons are gone—due to injury or diseases like 

AMD—they are typically gone for good. However, lessons 

Current Research
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from nature suggest that it may possible to overcome this 

limitation. For example, in some fish and amphibians, if 

the retina is damaged, it can grow back. Through targeted 

research, the NEI AGI aims to unlock these secrets and 

utilize them in humans—to develop new therapies to 

regenerate neurons and neural connections in the eye and 

visual system. 
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Additional Resources

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

www.eyecareamerica.org (Online Referral)

American Foundation for the Blind

2 Penn Plaza, Suite 1102

New York, NY 10121

1–800–232–5463

212–502–7600

Email: afbinfo@afb.net

www.afb.org

American Optometric Association

243 North Lindbergh Boulevard, Floor 1

St. Louis, MO 63141–7851

314–991–4100

1-800-365-2219

www.aoa.org
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Association for Macular Diseases

210 East 64th Street, #8

New York, NY 10065

212–605–3719

http://macula.org

Council of Citizens with Low Vision International

2200 Wilson Blvd. Suite 650

Arlington, VA 22201

1–800–733–2258

Email: president@cclvi.org

www.cclvi.org

The Foundation Fighting Blindness

7168 Columbia Gateway Drive, Suite 100

Columbia, MD 21046

1–800-683-5555

410-423-0600

Email: info@fightblindness.org

www.fightblindness.org

Macular Degeneration Partnership

6222 Wilshire Blvd., Suite 260

Los Angeles, CA 90048

1–888–430–9898

310–423–6455

www.amd.org
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National Eye Institute

National Institutes of Health

2020 Vision Place

Bethesda, MD 20892–3655

301–496–5248

Email: 2020@nei.nih.gov

www.nei.nih.gov

Prevent Blindness

211 West Wacker Drive, Suite 1700

Chicago, IL 60606

1–800–331–2020

Email: info@preventblindness.org

www.preventblindness.org

Additional Resources
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Notes

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Eye Institute

Revised 9/15