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Age-related macular degeneration (AMD)
AMD is a disease of the photoreceptor–retinal pigment epithelium (RPE)–Bruch membrane unit at the macula; in the dry form vision falls slowly from atrophy, and in the wet form new vessels under the retina (MNV) cause distortion and rapid loss, which are treated with anti-VEGF injections.
Why it matters in the exam
The exam presents an older patient with distortion of lines (metamorphopsia) on an Amsler grid or a central blind spot and asks what the finding is and what to decide. On OCT: subretinal or intraretinal fluid and RPE detachment point to wet disease; drusen and geographic atrophy to dry disease. Fluorescein angiography or OCT-A confirm MNV. The risk factors: age, smoking (the most important modifiable factor), the CFH and ARMS2 genes, European ancestry and family history.
In the dry form no treatment restores vision. AREDS2 supplements — vitamin C 500 mg, vitamin E 400 IU, zinc 80 mg, copper 2 mg, lutein 10 mg and zeaxanthin 2 mg — cut the 5-year rate of progression to advanced AMD by roughly 25%; they are indicated only for intermediate AMD, or for advanced AMD in one eye. In smokers beta-carotene (from the original AREDS) raised the risk of lung cancer and was therefore replaced. Geographic atrophy now has complement inhibitors (pegcetacoplan, avacincaptad pegol) that slow its growth but do not improve vision.
In the wet form intravitreal injections — ranibizumab, aflibercept, bevacizumab, faricimab — preserve vision in most patients and improve it in some. Treatment starts with monthly injections and moves to a treat-and-extend schedule guided by fluid on OCT. Every patient should check an Amsler grid at home and come quickly when new distortion appears. Polypoidal choroidal vasculopathy, commoner in people of Asian ancestry, is diagnosed with ICG and also treated with PDT. Low-vision rehabilitation — magnifiers, good lighting and training — is part of care at any stage in which central vision is affected.
Key points
- AMD damages the RPE and Bruch membrane at the macula.
- Smoking is the most important modifiable risk factor.
- AREDS2 for intermediate AMD or advanced AMD in one eye.
- Wet = MNV → anti-VEGF, then treat-and-extend.
- Home Amsler grid and urgent OCT for new distortion.
Summary table
| Form | Finding | Treatment |
|---|---|---|
| Early AMD | Medium drusen | Follow-up, stop smoking |
| Intermediate AMD | Large drusen or pigment changes | AREDS2 supplements, home Amsler grid |
| Geographic atrophy | Sharply demarcated area of RPE atrophy | Follow-up; complement inhibitors in selected cases |
| Wet AMD (MNV) | Fluid or blood under the retina, distortion | Monthly anti-VEGF, then treat-and-extend |
| Polypoidal choroidal vasculopathy | Polyps on ICG, subretinal haemorrhage | Anti-VEGF with or without PDT |
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Sources
- AAO Preferred Practice Pattern: Age-Related Macular Degeneration, 2019 — Diagnosis, nutritional supplements and anti-VEGF therapy
- AREDS2 Research Group: Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration, 2013 — Results
- AAO Basic and Clinical Science Course, Section 12: Retina and Vitreous, 2024-2025 — Age-related macular degeneration
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.