What Is Macular Degeneration? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Macular degeneration is an eye disease that affects the macula, or the central portion of the retina, which is the innermost layer at the back of the eye. The risk of developing this condition increases with age, which is why it is also known as age-related macular degeneration (ARMD or AMD). It is most likely to occur after age 55, though it can develop earlier, according to the American Macular Degeneration Foundation (AMDF).

The macula is made up of millions of light-sensing cells that provide sharp, central vision.

Normally, the retina converts light into electrical signals and transmits these signals through the optic nerve to the brain, which then transforms them into actual images, allowing you to see, according to the American Academy of Ophthalmology (AAO).

When the macula, the most light-sensitive part of the retina, is damaged, the center of your field of vision may appear blurry, distorted, or dark. The presence of macular degeneration is indicated by the accumulation of yellow deposits beneath the retina, known as drusen.

Age-related macular degeneration affects an estimated 20 million people in the United States and is the leading cause of vision loss and blindness, according to an original investigation published in November 2022 in JAMA Ophthalmology.

Macular degeneration doesn’t cause total blindness, because it doesn’t affect peripheral vision. However, it can significantly interfere with daily activities — such as the ability to drive, read, write, cook, do certain chores, and recognize faces or colors.

It's possible to have macular degeneration in only one eye, or to have a more severe form of the condition in one eye than the other.

The basic symptoms of macular degeneration are:

• Reduced or distorted central vision in one or both eyes
• Reduced ability to see or differentiate colors
• A blind or blurry spot, usually in your central visual field
• General haziness in your overall vision

The condition has few symptoms in the early stages, and sometimes, when the condition begins in only one eye, the unaffected eye compensates, so you may not immediately notice changes in your vision.

However, an eye doctor will be able to see signs of macular degeneration before symptoms appear — one reason regular eye exams are vital for early diagnosis, says the National Eye Institute.

If you notice changes in your central vision, or in your ability to see colors and fine detail, see an eye doctor promptly.

As macular degeneration progresses, the blurred area near the center of your vision may grow larger, or you may develop blank spots in your central vision.

Age-related macular degeneration comes in two forms:

• Dry macular degeneration, which is also known as atrophic AMD because of the thinning, or atrophy, of the macula
• Wet macular degeneration, also known as neovascular AMD because of the abnormal blood vessel growth that occurs behind the macula in this advanced stage of the disease

Dry Macular Degeneration

Dry AMD accounts for about 90 percent of macular degeneration cases.

In people who have dry AMD, the light-sensitive cells in the macula and the supportive tissue beneath it gradually break down, resulting in vision loss. And while dry AMD typically affects both eyes, if it affects only one eye, or affects one eye significantly more than the other, you may not notice any vision changes, because your healthy eye may compensate for the affected eye, notes the BrightFocus Foundation.

There are three stages of dry AMD: early, intermediate, and late.

Any stage of dry AMD can progress to wet macular degeneration, per the National Eye Institute.

Wet Macular Degeneration

Wet macular degeneration affects about 10 percent of people with AMD.

Wet AMD can develop in one of two ways:

1. In some cases, vision loss is caused by abnormal blood vessel growth from the choroid (a layer of blood vessels between the retina and the sclera) and into the macula. This is called choroidal neovascularization. These abnormal blood vessels may leak fluid or blood, interfering with retinal function.
2. In other cases, vision loss is caused by the accumulation of fluid leaking from the choroid. This fluid can collect between the choroid and the eye's retinal pigment epithelium (RPE, a pigmented layer of the retina located just behind the light-sensitive macular layers), causing a swollen, distorted area in the macula, notes Mayo Clinic.

The primary symptom of wet AMD is visual distortion — things that should appear straight appear bent or wavy instead — or a blind spot in the central vision.

Wet macular degeneration gets worse much more quickly than dry macular degeneration.

Learn More About Wet vs. Dry Age-Related Macular Degeneration (AMD)

Although macular degeneration in general, and age-related macular degeneration in particular, progresses more rapidly in some people than in others, there are three general stages:

Early Dry AMD

In this presymptomatic stage, your retina develops medium-sized drusen (about the width of a human hair), but you may not notice any vision loss.

The drusen will be noticeable in a routine eye exam, according to the BrightFocus Foundation.

Intermediate Dry AMD

In the intermediate stage of dry AMD, larger drusen accumulate in your retina, and you may also have pigment changes in your retina. You may or may not experience a blurry spot in the center of your vision, and you may notice you need more light for tasks such as reading. In either case, the changes in your retina will be detectable during an eye exam.

Late Dry or Wet AMD

Advanced dry AMD is also called geographic atrophy because of the patchy areas of the retina that degenerate and die at this stage, resulting in blind spots.

Wet macular degeneration, in which blood vessels leak fluid into or behind the macular, is always considered a late stage of AMD.

It's possible to have both late dry AMD and wet AMD in the same eye, and either condition can appear first, although commonly, dry AMD precedes wet.

Stargardt Disease

A third form of macular degeneration is known as Stargardt disease, named for the German ophthalmologist Karl Stargardt, who reported the first known cases of the disease in 1909.

Unlike age-related macular degeneration, Stargardt disease typically develops in people between the ages of 6 and 20.

It is the most common form of inherited juvenile macular degeneration, with about 30,000 cases in the United States, according to Foundation Fighting Blindness.

According to the Genetic and Rare Diseases Center of the National Center for Advancing Translational Sciences, Stargardt disease is most commonly inherited in an autosomal recessive manner — meaning both parents have to pass down the ABCA4 gene mutation for a child to have the condition — although it may rarely be caused by other genetic mutations and passed down in an autosomal dominant manner, meaning only one mutated gene from one parent is necessary for a child to have the disease.

In Stargardt disease, photoreceptor cells in the macula die. As a result, tiny deposits called lipofuscin accumulate in the retinal pigment epithelium, leading to damage and progressive loss of vision, per the AMDF.

Stargardt disease typically affects both eyes and initially causes difficulty reading or adjusting to the light when going from bright to dark spaces, according to the AAO.

Like AMD, Stargardt disease doesn’t typically lead to total blindness; it causes blurriness in the central vision, progressing to loss of central vision, while peripheral vision remains normal. Treatment often requires the use of vision aids to maximize peripheral vision.

People with Stargardt disease are advised not to take excessive amounts of vitamin A because the cells in their eyes can’t metabolize the nutrient, so it can be toxic to them.

The exact cause of age-related macular degeneration is unknown, but the disease has been linked to both genetic and environmental factors.

In general, people with a family history of the condition are at higher risk, according to the American Macular Degeneration Foundation.

Several genes have been linked to age-related macular degeneration (such as the ABCA4 gene), but research in this area is still in its early stages, and it’s not yet clear whether knowing this genetic information would help in regard to treatment, according to a review published in Clinical Interventions in Aging.

Dry AMD, for instance, may also be associated with environmental factors, including smoking and diet, as well as race and obesity.

Certain personal characteristics and lifestyle measures are associated with a higher or lower risk of AMD:

Age Increasing age is one of the main risk factors for developing age-related macular degeneration.

Smoking Cigarette smoking is linked by research to both higher risk and faster progression of AMD.

Saturated Fat You’re at greater risk of developing AMD if your diet is high in saturated fat, says the AAO.

Obesity Being obese is a key risk factor for developing AMD, says a review in the journal Clinical Therapeutics.

Race and Ethnicity Being Caucasian or Hispanic puts you at higher risk of macular degeneration than being Black, research shows.

Cardiovascular Disease People with high blood pressure, atherosclerosis (“clogged” arteries), or a history of cardiovascular disease are at higher risk for macular degeneration, studies have shown.

Sun Exposure Long-term exposure to sunlight without proper eye protection is another risk factor for AMD, the AMDF says.

To diagnose macular degeneration, your eye doctor may perform several tests, including:

• A basic eye exam
• Amsler grid test
• Fluorescein angiography
• Optical coherence tomography

Basic Eye Examination

An examination of the back of your eye will most likely come first. After dilating your pupils with eye drops, your doctor will check for damage caused by drusen or accumulated fluids.

Amsler Grid

To check for defects in the center of your vision, your doctor may use a test called an Amsler grid. If you have macular degeneration, some of the straight lines in the Amsler grid will look faded, broken, or distorted, according to Mayo Clinic.

Fluorescein Angiography

In fluorescein angiography your doctor will inject a colored dye into a vein in your hand or arm that will travel to the blood vessels in your eye, highlighting them, then use a special camera to take pictures as the dye travels through your blood vessels to check for abnormalities or retinal changes. This testing takes about 20 minutes and requires dilating the pupils, notes the AMDF.

Optical Coherence Tomography

Optical coherence tomography (OCT) is a noninvasive test that produces detailed cross-sectional images of your retina, allowing your doctor to spot areas of thinning, thickening, or swelling. This test is also used to help monitor how the retina responds to treatment.

Genetic Testing for Stargardt Disease

Genetic testing may be used to identify young people at risk for Stargardt disease; eventually, scientists hope that a gene therapy approach might work to replace the defective genes that cause Stargardt or AMD, though this is likely several years into the future.

Prognosis of Macular Degeneration

Developing early AMD does not guarantee that you will develop late AMD or that you will experience significant vision loss. Even those who develop late-stage AMD do not develop total blindness, although the condition does affect the ability to read, drive, and recognize faces at a distance.

While there is currently no cure for any form of macular degeneration, available treatments may prevent severe vision loss or slow the progression of the condition.

The length of time it takes for AMD to progress from early- to late-stage varies from person to person. Research suggests that up to 3 percent of people with small drusen deposits in the macula experience vision problems within five years of their diagnosis, while about 50 percent of people with larger drusen develop late-stage AMD and vision loss within five years, per InformedHealth.org.

Dry AMD can also turn into wet AMD, which quickly worsens if left untreated, but it can be stopped or slowed down by various treatments.

The bottom line: A diagnosis of AMD likely means you’ll be dealing with the effects of the condition for the rest of your life. But current treatments can slow its progression so that you can preserve your vision longer.

Although there’s no cure for macular degeneration, several different approaches may be used to treat the condition and slow its progression.

Supplements for Intermediate-Stage Dry AMD

For intermediate dry macular degeneration, a daily combination of vitamins and nutritional supplements has been shown to slow progression, says the AAO.

AREDS and AREDS2 formulas (like PreserVision AREDS2) are nutritional supplements that reduce the risk of a person progressing to advanced age-related macular degeneration. The formulas are based on the National Eye Institute (NEI)–funded Age-Related Eye Diseases Studies (where the names AREDS and AREDS2 come from).

The AREDS study found that some people with dry AMD can reduce their risk for developing wet AMD and vision loss by taking vitamins C, E, beta-carotene, zinc, and copper supplements.

The second study, AREDS2, showed that substituting lutein and zeaxanthin for beta-carotene can produce similar results in active cigarette smokers for whom beta-carotene could increase the risk of lung cancer.

It’s now possible to buy AREDS2 supplements over the counter in drugstores, but you should consult your eye doctor before taking them. They aren’t likely to be helpful if you already have late-stage AMD, and they can interact with some medications, according to the NEI.

Anti-VEGF Medications for Wet AMD

If you have wet macular degeneration, certain medications can stop growth of new, abnormal blood vessels in the macula. These drugs, which are injected into the eye, are called anti-vascular endothelial growth factor (anti-VEGF) therapies, and include:

• aflibercept (Eylea)
• bevacizumab (Avastin)
• brolucizumab (Beovu)
• ranibizumab (Lucentis)
• faricimab-svoa (Vabysmo)

The treatment, which may require repeated, monthly injections, has been shown to restore vision in some people with AMD, and prevent blindness in up to 90 percent of those who receive it.

If the treatment is effective, you may recover some lost vision as the blood vessels shrink and the fluid under the retina is absorbed.

Vabysmo, approved by the U.S. Food and Drug Administration in early 2022, targets two proteins — vascular endothelial growth factor-A (VEGF-A) and angiopoietin-2 (Ang-2) — that, through separate mechanisms, lead to unstable blood vessels, inflammation, and fluid leakage into the macula.

Similar to the other anti-VEGF therapies, Vabysmo is injected into the eye, but in clinical trials, some participants were able to increase the time between treatments from 4 to 16 weeks without losing benefits.

Anti-VEGF drugs are also sometimes used to treat Stargardt disease, according to the AMDF.

Potential side effects of anti-VEFG drugs include:

• Bleeding within the eye
• Floaters (spots, threads, or other shapes that appear in your field of vision)
• Increased intraocular pressure, which can lead to glaucoma
• Retinal detachment
• In very rare cases, infections within the eye may occur after injection, requiring immediate treatment.

Medical and Surgical Procedures for Wet AMD

A couple of noninvasive procedures may stop leaky blood vessels in wet macular degeneration:

Photodynamic Therapy In this therapy a doctor injects the light-activated drug verteporfin (Visudyne) into a vein in your arm, then shines a special light into the eye to activate the drug. This causes the leaky blood vessels to close, preventing further damage to the macula. Multiple treatments may be necessary, because treated blood vessels can reopen, notes Johns Hopkins Medicine. However, verteporfin photodynamic therapy for AMD has largely been replaced by anti-VEGF treatment.

Laser Photocoagulation In this older procedure, a laser is used to seal off abnormal blood vessels. However, this treatment is less helpful if the abnormal blood vessels are scattered across the macula — rather than bunched in one place — or if they’re located in the central area of the macula.

Low-Vision Rehabilitation

People with any type of macular degeneration may benefit from low-vision rehabilitation — a type of therapy that helps them adapt to their changing vision and maintain their independence.

A low-vision rehabilitation specialist, occupational therapist, eye doctor, or other trained healthcare professional can teach individuals with AMD or Stargardt disease to perform daily activities by using strategies that compensate for missing areas of vision.

Lessons generally include how to modify one’s home environment, use low-vision devices, and find ways to make full use of the healthy portions of sight, which often involves the peripheral vision.

Available low-vision devices include a variety of external video magnifiers and specialized monocular and binocular spectacles that can help people with AMD maximize their remaining vision. The American Foundation for the Blind provides an extensive list of video magnifiers with different features and uses, as well as a list of low-vision optical devices, which include handheld magnifiers and magnifying reading glasses. Similarly, VisionAware provides information on a wide range of low-vision devices.

Studies show that people who complete a vision rehabilitation program can often significantly improve their functional abilities and enhance their overall quality of life.

To find a vision rehabilitation specialist near you, go to the American Academy of Ophthalmology’s directory. Be sure to select “vision rehab” in the subspecialty category.

You can also look for vision rehabilitation services by state through the website of Living Well With Low Vision.

Learn More About Treatment for Age-Related Macular Degeneration

Research Into New Treatments for AMD

Researchers are studying new and innovative ways to treat AMD.

One therapy that’s showing promise is using stem cells to treat dry AMD. Investigators from the National Eye Institute have successfully used this treatment in animals to prevent blindness and are now testing it in humans.

Gene therapy is another treatment on the horizon that could help people with wet and dry AMD. The goal of this one-time injection is to help the eye manufacture its own anti-VEGF medicine. Researchers are currently studying several gene therapy drugs, but the long-term effectiveness is unknown at this point.

Another advance in treatments for wet AMD that’s currently being tested is a refillable drug reservoir that stores anti-VEGF medicines. It’s implanted into the wall of the eye and continuously releases the drug to the back of the eye over time. Instead of injections every few weeks, patients might be able to fill the port once or twice a year.

Electronic, light-sensitive devices are also being experimentally implanted into the eye in an attempt to bypass the damaged macula and deliver image data to the brain for processing. In one study, researchers found that the combination of an implanted chip and specially designed glasses restored limited central vision in study participants. What’s more, the prosthetic vision integrated with the subjects’ natural peripheral vision, meaning they could see coherent images. However, the existing system provides very low visual acuity, so more research is needed to create devices that deliver more functional vision.

Certain steps can reduce your risk of developing age-related macular degeneration and help manage your condition if you already have it.

• Quit smoking, since smokers are more likely to develop macular degeneration.
• Get regular exercise.
• Maintain a healthy weight.
• Follow a diet rich in antioxidant and other nutrients, typically found in vegetables and fruits, along with fish.
• Wear sunglasses with maximum UV protection and a hat when you spend time outdoors, particularly if you take photosensitizing drugs.

Following a healthy diet may also help slow progression of AMD and delay or even reduce vision loss. A study with nearly 5,000 participants found that close adherence to the Mediterranean Diet, which emphasizes vegetables, whole grains, fish, fruit, nuts, legumes, and olive oil, is linked with lower rates of advanced AMD.

Taking AREDS or AREDS2 vitamin and mineral supplements can prevent intermediate-stage AMD from turning into late AMD, per the NEI.

Getting regular dilated eye exams is also recommended to identify any signs of eye disease early so it can be treated promptly.

In addition to its primary symptom of vision loss, macular degeneration raises the risk of certain complications, including the following:

Detached Retina AMD can cause exudative retinal detachment, in which fluid accumulates beneath the retina, pushing it away from the back of the eye, according to the National Eye Institute. Any type of retinal detachment is a medical emergency. Symptoms of a detached retina include new floaters, new flashing lights, and a gray or black curtain over part of your vision.

Depression and Anxiety People with vision loss are at increased risk for anxiety and depression. Research shows that people with more advanced stages of AMD and people with lower visual acuity have worse mental health than those with less advanced or less severe AMD.

Hallucinations People with vision loss, including vision loss from AMD, sometimes experience visual hallucinations, a condition known as Charles Bonnet syndrome, according to the AAO. These hallucinations may appear as flashes of light, colors, or shapes, although many people see geometrical grids and lattices, and others see landscapes, people, or imaginary beings.

A variety of techniques can be tried to help stop the hallucinations when they occur, including changing the lighting in your environment and moving your eyes or opening and closing them. Describing your hallucinations to others or joining a support group for people with Charles Bonnet syndrome can also help reduce feelings of distress related to the experience.

For many people, the hallucinations stop or occur less frequently over time.

Approximately 20 million people in the United States are living with age-related macular degeneration, research suggests. That number is expected to increase over time, due to the aging population.

In addition, an estimated 30,000 people in the United States have been diagnosed with Stargardt disease, an inherited form of macular degeneration that can start in childhood.

According to research published in 2022, Black individuals are less likely to have early-stage macular degeneration than either white or Hispanic Americans. Among adults ages 40 and older, just over 7 percent of Black Americans have early-stage AMD, while just over 12 percent of Hispanic and white Americans have it.

The same research found that 0.38 percent of Hispanic and 0.65 percent of Black Americans have late-stage AMD, while 1.03 percent of white Americans have it.

Macular degeneration is the leading cause of vision loss in people ages 50 and older. However, there are other eye conditions to be aware of as you age.

Cataracts

Cataracts involve the clouding of the lens of the eye and are a common manifestation of aging, typically appearing around age 50 to 60. According to the National Eye Institute, more than 50 percent of Americans age 80 and older have cataracts or have had surgery to remove them.

Lifestyle measures including wearing sunglasses and a hat in the sun and eating plenty of fruits and vegetables may lower the risk of cataracts, while smoking and consuming high amounts of alcohol raise the risk.

Cataracts are treatable, and essentially curable, with surgery. Once removed, a cataract cannot "regrow," although a membrane intentionally left in place to support the artificial intraocular lens (which replaces the removed lens) typically becomes hazy over time. This has been called a "second cataract," which is an inaccurate description; it is not another cataract, and is easily treated with a simple laser procedure.

Diabetic Retinopathy

Diabetic retinopathy is the most common eye problem associated with diabetes. It occurs when chronic or frequent high blood sugar levels cause damage to the blood vessels of the retina. Symptoms may include blurred vision, fluctuating vision, a sudden shower of floaters (dark specks) in your vision, and dark or empty areas of vision, according to the American Diabetes Association.

Improvements in blood sugar control, as well as blood pressure and cholesterol control, and cessation of smoking can slow the progression of diabetic retinopathy. If necessary, advanced retinopathy can be managed with injected medications, laser treatments, and, in some cases, surgery.

People with diabetes are advised to have a yearly dilated eye exam to look for signs of retinopathy so that if necessary, it can be treated early. When diabetes is tightly controlled, it is not usually necessary for any intervention to be done. Regular eye exams, however, are still needed to identify those cases that require treatment.

Glaucoma

Glaucoma is a collection of eye conditions that can eventually damage the optic nerve — usually as a result of increased pressure in the eye, or intraocular pressure. Glaucoma can lead to loss of peripheral vision and, over time, cause total blindness if it’s left untreated. It can be prevented by lowering intraocular pressure with topical eye drops or surgery.

As with other chronic eye conditions, regular follow-up exams are necessary for people who have glaucoma, and treating glaucoma usually requires lifetime topical eye medications to prevent optic nerve damage and associated visual loss.

Presbyopia

At about age 40, most adults develop a normal condition called presbyopia, which typically affects near vision. It is not usually a significant problem for nearsighted people ("myopes") for some time, but those who do not wear glasses, or farsighted people ("hyperopes") will usually be symptomatic early. Hyperopes, in particular, may also notice blurring of their distance vision.

These age-related changes are easily corrected with the use of glasses as needed.

Dry Eye

Older adults, particuarly women, and those with autoimmune diseases (such as thyroid disease, rheumatoid, and lupus) are also more prone to an eye condition called dry eye, which is caused by reduced or abnormal tear production. People with dry eye don’t produce adequate tears to keep their eyes properly lubricated, which can cause discomfort, including redness, stinging, a “sandy” feeling, and burning. An abnormal “tear film” may also impact vision, causing some blurring at distance and near.

There isn't a cure for dry eye, but supplemental lubrication with artificial tears can usually help relieve many of the symptoms. In some cases, the tear outflow ducts may need to be occluded to reduce tear drainage, and some prescription drugs can also help manage the condition.

If you or someone you know has been diagnosed with AMD, there are many resources available to help you manage this common disease. Here are some top picks:

American Academy of Ophthalmology

As the world’s largest association of eye physicians and surgeons, the American Academy of Ophthalmology has 32,000 medical doctors as members. Its website features important information about various conditions affecting the eye, including AMD.

American Macular Degeneration Foundation (AMDF)

The AMDF is a nonprofit organization that’s committed to the prevention, treatment, and cure of macular degeneration. It provides support and education to people with AMD and their families while also promoting awareness.

American Printing House for the Blind

Since 1858, this nonprofit organization has offered hundreds of useful products and services for people who are blind or visually impaired. These include braille textbooks, talking calculators, and tactile globes.

Be My Eyes App

This free app connects people who are blind or have low vision with sighted volunteers who can provide assistance via a live video call. It’s now available in 180-plus different languages in more than 150 countries.

BrightFocus

BrightFocus is an organization that funds scientific research and provides information about Alzheimer’s disease, macular degeneration, and glaucoma. Additionally, it offers a list of prescription assistance programs for people with macular degeneration.

E.A.R.S. for EYES Program

E.A.R.S. is a nonprofit organization that provides free audio lessons that teach adaptive daily living skills to people who are vision impaired and their caregivers. The program offers a national directory of low-vision support groups.

HomeMods.org

This website, which is a project sponsored by the University of Southern California (USC) Leonard Davis School of Gerontology, provides information and resources for how to make the homes of the visually impaired safer. The idea is to modify living spaces to reduce the risk of falls and other injuries.

International Association of Audio Information Services (IAAIS)

The IAAIS is a volunteer-driven organization that turns text into speech for people who can’t see or have a disability that prevents them from reading.

NFB-Newsline

NFB-Newsline is a free nationwide audio news service for people who are blind, have low vision, are deaf-blind, or otherwise print disabled. It provides access to more than 500 publications, emergency weather reports, job listings, and more.

NIH: National Eye Institute

For more than 50 years, the NIH’s National Eye Institute has been at the forefront of vision research. The organization provides a wealth of educational materials. From fact sheets to webinars, its resources can help you learn more about AMD and how to cope with vision loss.

PreventBlindness.org

The goal of the organization is to prevent blindness and preserve sight. We especially like that it offers an Amsler grid test to download and print, so that you can check your vision and track any changes. The organization also has a resource called GuideME, which creates a customized guide with helpful information for people with vision problems.

That All May Read

Sponsored by the National Library Service (NLS) of Congress, this program is a free braille and talking-book library service for people with temporary or permanent low vision, blindness, or a disability that inhibits them from reading or holding a printed page.

VisionAware

VisionAware is a free, easy-to-use service for people with vision loss, their families, and health professionals. The site provides a feature that allows you search for local support groups and organizations in your area. VisionAware also offers helpful information about low vision devices.

VoiceOver App

This app, which can be used on a variety of Apple devices, allows visually impaired people to navigate all their screens. Users hear a description of what’s on the screen, including menu items, text messages, and battery life alerts.