Retina
AMD: what it is, how it is treated and when to get a second opinion
Age-related macular degeneration (AMD) is the most common cause of central vision loss in people over 55 in developed countries. Understanding it, and understanding your scans, makes a real difference to how you live with treatment.
By Dr Idaira Sánchez Santos, ophthalmologist · Nº 390905425
Last reviewed: · Patient information. It does not replace a medical consultation.
What AMD is
The macula is the centre of the retina, the part we use to read, recognise faces or look at a phone. In AMD this area deteriorates with age. Side vision is preserved, so AMD does not cause total blindness, but it can make reading or driving very difficult.
There are two forms:
- Dry (atrophic) AMD: the most common. It progresses slowly, with deposits (drusen) and, in late stages, areas of atrophy.
- Wet (neovascular) AMD: abnormal vessels grow under the retina and leak fluid or blood. It progresses over weeks and causes the most vision loss if not treated promptly.
Symptoms to know
- Straight lines look wavy or bent (metamorphopsia).
- A grey or blurred patch in the centre of your vision.
- Difficulty reading small print even with new glasses.
- Faded colours or needing much more light.
A simple check at home is to look at a grid (Amsler grid) or a door frame with each eye separately. If something that used to look straight now looks bent, see your ophthalmologist soon.
How it is diagnosed
The key test is macular optical coherence tomography (OCT): a scan that shows the layers of the retina and reveals fluid, blood or atrophy. It is complemented by retinal photographs and, in some cases, angiography or OCT-angiography.
Treatment
For wet AMD the standard treatment is intravitreal injections of anti-VEGF drugs, which block the abnormal vessels. Treatment starts with several monthly doses and the interval is then adjusted according to the OCT. Keeping to the right schedule is what best protects vision in the long term.
For dry AMD, AREDS2-formula supplements may be recommended at intermediate stages, together with stopping smoking and looking after blood pressure and diet. New drugs for advanced atrophy are being developed, and their availability varies from country to country.
When an online consultation helps
- You want a second opinion on whether you need injections or on the schedule you have been offered.
- You have been told there is "fluid" or that it is "dry" and you want to understand your OCT.
- You have been on treatment for a while and wonder whether injections can be spaced out or the drug changed.
- An older relative has AMD and you want to understand the diagnosis and options calmly.
Which tests to send the doctor
- Macular OCT of both eyes (the more dates the better, to see progression)
- Reports from your ophthalmologist and injection history (dates and drug)
- Visual acuity from recent check-ups
- Retinal photos or angiography if you have them
If you suddenly notice a central blur or wavy lines in an eye that used to see well, do not wait for an online consultation: get an urgent in-person appointment with an ophthalmologist within days.
Frequently asked questions
Does AMD cause total blindness?
No. It affects central vision, while side vision is preserved. Even so, untreated wet AMD can cause major loss of the vision you need to read or recognise faces.
Do the injections hurt?
They are given with anaesthetic drops under sterile conditions. Most patients feel pressure rather than pain, and the discomfort is brief.
Can AMD be assessed over video?
Your OCT and history can be interpreted in detail, treatment can be discussed and your questions answered. What cannot be done over video is examining the back of the eye or giving injections.