Types of Macular Degeneration

Macular degeneration is typically categorized as either dry (non-neovascular) or wet (neovascular). The dry form is more common and is often considered the early stage of the condition. It tends to develop as the macula thins over time with age, and small pigment deposits may also build up in the area.

Only about 10% of individuals experience progression to the more severe wet form. In these cases, abnormal blood vessels begin to grow beneath the macula, leading to leakage of blood and fluid. This can cause blind spots and lasting damage to central vision. However, peripheral vision usually remains unaffected regardless of the type.

Stages of Macular Degeneration

There are three stages of AMD. These stages are designated both by signs detected by the ophthalmologist and symptoms experienced by the patient.

Early Stage AMD

In the early stages of age-related macular degeneration (AMD), a physician may identify the condition by detecting an increased number of medium-sized drusen—yellow deposits that form beneath the retina. At this stage, most individuals do not experience noticeable vision loss.

Intermediate Stage AMD

In intermediate age-related macular degeneration (AMD), larger drusen are typically present, and changes in retinal pigment may also be observed. Some individuals may begin to notice minor gaps in their vision, but most people at this stage do not experience substantial vision loss.

Late Stage AMD

During late stage AMD, patients have enough damage to the macula to experience significant vision loss. The two types of late AMD are:

1. Dry, or geographic, in which macula tissue degenerates

2. Wet, or neovascular, in which abnormal blood vessels grow

Wet age-related macular degeneration (AMD) tends to progress more quickly than the dry form. In wet AMD, newly formed blood vessels under the retina may leak blood and fluid, leading to more rapid and severe vision loss. In contrast, vision changes in dry AMD typically develop more slowly. While about 90% of AMD cases are initially diagnosed as dry, around 10% of those may eventually progress to the wet form. Both types can cause vision impairment, but wet AMD is generally associated with more significant and faster vision deterioration.

Risk Factors for Macular Degeneration

While aging increases the risk of macular degeneration for everyone, certain individuals face a higher likelihood due to genetic or environmental factors. One such factor is a genetic variation called complement factor H, which has been linked to a greater susceptibility to the disease. In fact, nearly 50% of macular degeneration-related blindness is associated with this genetic trait.

The condition is more frequently seen in women and individuals with lighter skin or eye color. Overall risk increases with age, and studies show that more than 30% of adults aged 75 and older have been diagnosed with intermediate or advanced age-related macular degeneration.

Other factors that may increase the risk of developing macular degeneration include:

• Obesity

• Smoking

• High fat diet

• Lack of exercise

• Elevated cholesterol levels

• Prolonged sun exposure

• High blood pressure

• Certain medications

Minimizing Risk of Macular Degeneration

There are three easy ways you can minimize your risk including:

• Exercise

• Eating a diet rich in Omega-3 fatty acids

• Getting regular eye examinations

Diagnosis of Macular Degeneration

An ophthalmologist can often identify early indicators of macular degeneration during a routine eye exam—even before any symptoms appear. This highlights the importance of scheduling regular eye examinations to support long-term eye health and early detection.

In order to definitively diagnose AMD, any or all of the following are necessary:

• Visual acuity test

• Physical examination of the back of the eye after dilation

• Amsler grid test for central vision

• Fluorescein angiogram, in which dye highlights the blood vessels

• Optical coherence tomography (OCT)

During an eye exam, the ophthalmologist carefully checks for drusen and any pigment changes beneath the retina—both early signs of macular degeneration. Detecting this condition, along with other serious eye diseases, as early as possible is key to preserving vision and preventing long-term damage.

Treatment of Macular Degeneration

While there is no cure for macular degeneration, there are several treatment options available to help patients manage this condition and preserve their vision. The best treatment option for each patient depends on the severity and type of the condition, as well as how much, if any, permanent vision loss has occurred.

Traditionally recommended treatments for AMD may include one or more of the following, each of which approaches controlling AMD in a somewhat different way:

• Vitamin and mineral supplementation known as AREDS or AREDS2

• Injections of anti-VEGF (vascular endothelial growth factor)

• Laser therapy

• Laser submacular surgery

• Use of low vision aids

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