Age-related macular degeneration

Stages And Types Of AMD

The early and intermediate stages of AMD are caused by the progressive build-up of waste material called ‘drusen’, under the retina. These stages typically have little or no impact on vision however some people, when they reach the intermediate stage, may start to notice changes to their central vision. According to Macular Disease Foundation Australia, currently there is no treatment available for the early and intermediate stages, and research is being conducted to develop treatments.

Progression to late stage AMD may occur, however progression can differ in each eye.

Late stage AMD is the vision impairing stage, which can be further divided into two types: dry (atrophic) and wet (neovascular) macular degeneration. Most AMD starts as the dry type, and in 10-20 per cent of people, it progresses to the wet type. AMD is always bilateral, which means it occurs in both eyes, but it doesn’t necessarily progress at the same pace in both eyes.

Dry macular degeneration affects approximately 80-90 per cent of people with AMD. It tends to progress more slowly than the wet type, and there is not yet an approved treatment or cure. In dry AMD, small white or yellowish deposits called drusen form on the retina beneath the macula, causing it to deteriorate over time.

Wet macular degeneration affects approximately 10-15 per cent of individuals with AMD, but accounts for approximately 90 per cent of all cases of severe vision loss from the disease. In wet AMD, abnormal blood vessels under the retina begin to grow toward the macula. Because the new blood vessels are abnormal, they tend to break, bleed and leak fluid, damaging the macula and causing it to lift up and pull away from its base. This can result in a rapid and severe loss of central vision.

Symptoms Of AMD

It is possible to have the very early signs of macular degeneration without even knowing. This is why it is crucial to have regular eye examinations with an optometrist, particularly if you are at risk of macular degeneration due to age, lifestyle factors or family history.

An optometrist can look at the back of the eye and identify early symptoms, such as the presence of drusen and/or leaky vessels. Drusen are yellow deposits under the retina. They are made up of lipids and proteins and detecting them indicates the person is at risk of developing AMD.

Macular Disease Foundation Australia lists noticeable symptoms of AMD as follows:

• Difficulty in reading or any other activity which requires you to see fine detail
• Distortion where straight lines appear wavy or bent
• Difficulty distinguishing faces
• Dark patches may appear in the centre of your vision
• Additionally, the need for increased illumination, sensitivity to glare, decreased night vision and poor colour sensitivity may also indicate something is wrong

It is important never to ignore any changes to your vision, or assume they are just a part of ageing. If there any sudden changes in vision or any of the above symptoms of AMD are noted, please make an appointment to see an optometrist straight away. If your optometrist detects AMD, they may need to arrange a rapid referral to see an ophthalmologist for treatment.

Who Gets AMD

The cause of AMD is unknown but it is linked to several factors.

The major risk factor for developing AMD is age, with one in seven people over 50 affected. People with a direct family history of the disease are also at greater risk of developing AMD.

Evidence suggests smoking is another key risk factor, with studies showing that people who smoke are three to four times more likely to develop AMD. Smokers may also develop the disease five to ten years earlier than non-smokers.

Other risk factors include high blood pressure, lighter eye colour and obesity. Some researchers believe that over-exposure to sunlight may also be a contributing factor in the development of AMD, but this theory has not been proven conclusively.

You should have an eye examination every one to two years which checks for the signs and symptoms of AMD if you:

• Are older than 50 years of age
• Are a smoker
• Have hypertension or cardiovascular disease
• Have a family history of AMD
• Have a history of increased UV exposure


Macular degeneration is caused by both genetic and environmental factors. Risk factors include age, family history and smoking

Image Credit: Pic by Clement Falize on Unsplash

AMD Diagnosis

Your optometrist will temporarily dilate your pupil with an eye drop and look inside your eye through a special lens to see if there are changes in the retina or macula. Your optometrist may ask you to look at an Amsler grid. This grid helps you notice any blurry, distorted or blank spots in your field of vision. They may also take a digital photograph or take an optical coherence tomography scan of your macula (OCT), for comparison at your next eye exam.

Once diagnosed with AMD your eye health professional will advise you on the course of action to take, according to the stage of the disease.

You may be referred to an ophthalmologist for further examination, diagnosis and treatment or asked to visit your optometrist on a regular basis to monitor disease progress. It is essential to follow recommendations and undertake regular eye exams.

Macular Disease Foundation Australia says that “once diagnosed with AMD, it is important to remain calm and seek advice from all available sources. Talk through the diagnosis with friends or family, before taking the time to calmly sort out the best pathway forward.

“Many people experience different feelings of disbelief, apprehension and even depression. However what may seem an insurmountable difficulty for someone experiencing vision loss for the first time can become just another aspect of daily life with some adjustments to everyday activities.”

Once diagnosed with AMD your optometrist will advise you on the course of action to take, according to the stage of the disease

Image Credit: Macular Disease Foundation Australia

AMD Treatment

There is as yet no outright cure for AMD, but some treatments may delay its progression or even improve vision.

Treatments will depend upon whether the disease is in the early or later stage, in its dry form, or the more advanced wet form that can lead to serious vision loss.

There are currently no medical treatments available for early or intermediate AMD, and late stage dry AMD, however a substantial amount of research is being conducted across the world to find a treatment. In the meantime, some evidence suggests that positive changes to diet and lifestyle may slow the progression of the disease.

It is important to be aware that dry macular degeneration can turn into the more severe wet macular degeneration, so regular eye examinations are crucial to pick up any changes early. Or, if any sudden changes to your vision are noticed, it is vital that you consult your optometrist or ophthalmologist immediately. Early detection of AMD can save your sight.

There are a number of medical treatments available for wet AMD. These treatments do not cure the disease but aim to stabilise and maintain the best vision for as long as possible. In some people, treatment can improve vision.

A protein called Vascular Endothelial Growth Factor, or VEGF, is predominantly responsible for the leaking and growth of new blood vessels that result in rapid and severe vision loss which, if left untreated, becomes permanent.

To slow or stop this process, various drugs that block the protein, called anti-VEGFs, may be injected into the eye.

Read here for more information about treatment for wet AMD

To help treat wet AMD, there are medications called anti-VEGF drugs. Anti-VEGF treatment helps reduce the number of abnormal blood vessels in your retina.

Video Credit: American Academy of Ophthalmology

Support For AMD Sufferers

Macular Disease Foundation Australia is the national organisation dedicated to supporting people with macular degeneration and to raise funds for research. For more information about Macular Disease Foundation Australia, call 1800 111 709 or visit www.mdfoundation.com.au

Commonly Asked Questions

What causes AMD?
There are two types of AMD: dry and wet. The dry form is more common and less severe. It causes a gradual deterioration in in your central vision over time. Dry AMD accounts for 90 per cent of all AMD but can change into the wet type over time. The wet form is less common and occurs when a blood vessel underneath the macula leaks and symptoms can progress rapidly. This type needs urgent treatment.

How will I know if I have AMD?
AMD causes no pain or discomfort and commonly progresses slowly. In its early stages, AMD may be detected in an eye examination before symptoms occur. The first symptom is typically difficulty seeing fine detail in the centre of your vision and over time, this central area may increase in size. In some cases, AMD may cause lines to appear distorted or wavy. A comprehensive eye examination with an optometrist will uncover any signs of macular degeneration if you have them.

Am I at risk of getting AMD?
The major risk for developing AMD is age, with one in seven people over 50 affected. Smoking is the major controllable risk factor with smokers having twice the risk of developing AMD. You should have an eye examination which checks for the signs and symptoms of AMD if you:

• Are older than 50 years of age
• Are a smoker
• Have hypertension or cardiovascular disease
• Have a family history of AMD
• Have a history of increased UV exposure

How does an optometrist diagnose AMD?
All eye examinations are painless. As part of your eye examination your optometrist will check the macula at the back of the eye. It is common for your optometrist to put eye drops in your eyes to dilate your pupils, when checking for AMD. They may need to take a photograph or scan of your macula for comparison at your next eye examination.

Can AMD be treated?
There is currently no treatment for dry AMD and those with dry AMD need regular eye examinations to ensure the wet form does not develop. A new treatment for wet AMD is now available in which an ophthalmologist injects anti-VEGF (anti vascular endothelial growth factor) into the eye, to prevent the growth of the abnormal leaky blood vessels. Anti-VEGF therapy is the first treatment of AMD that has been shown to improve vision in some cases. The treatment needs to be repeated, commonly each month, as part of the ongoing treatment of the disease.
This treatment aims to keep the best vision for as long as possible. The early detection of any form of AMD is important because the earlier AMD is detected and treated, the better your vision is likely to be in the future.
I have macular degeneration, is there a support network that I can turn to?
Yes. We recommend that you contact Macular Disease Foundation Australia, the national organisation dedicated to supporting AMD sufferers. For more information about Macular Disease Foundation Australia, call 1800 111 709 or visit www.mdfoundation.com.au

Who Do I See About My Vision?

We recommend making an appointment with an optometrist for a comprehensive eye examination. Comprehensive eye examinations, at regular intervals starting from childhood, ensure that most eye conditions can be prevented or corrected. Eye examinations can also be an important tool for determining your overall health.

Use our Find an optometrist search function if you do not have an optometrist, or would like to find an optometrist close to where you live.

Published date: 01 September 2016 Reviewed date: 27 April 2020

Author: Sophie Koh, National Professional Services Adviser at Optometry Australia

Bio: Sophie Koh is an experienced optometrist who started her career in the Northern Territory. She has broad experience working in public health and corporate settings across metropolitan, rural and outback Australia. She has extensive experience working in ophthalmology teams and training nurses in East Timor, Papua New Guinea and Solomon Islands. Sophie studied her undergraduate degree at the University of Melbourne and was amongst the first cohort of graduates to achieve the ACO Certificate in Ocular Therapeutics. She is currently the National Professional Services Adviser at Optometry Australia. She is passionate about public health and Indigenous eye health. She is devoted to empowering students and colleagues to improve their knowledge and skills so they can play a wider role in improving the health and wellbeing of our underprivileged communities locally and overseas.

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Disclaimer: No information provided on the Good vision for life website is intended to constitute or substitute advice from visiting an optometrist. Many factors unknown to us may affect the applicability of any information on this website. You should seek appropriate personalised advice from a qualified optometrist about any eye health and vision conditions.