Age-Related Macular Degeneration (AMD)
Dry and wet AMD — anti-VEGF therapy, NICE guidance and preserving central vision
Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in people over 50 in the UK, affecting around 700,000 people. It damages the macula — the part of the retina responsible for sharp central vision needed for reading, driving, and recognising faces. There are two forms: dry AMD, which progresses slowly, and wet AMD, which can cause rapid and severe vision loss and requires urgent treatment. Careful evaluation and early referral are critical in preserving sight.
What is the Macula and Why Does AMD Affect Vision?
The macula is a small, highly specialised area at the centre of the retina responsible for fine detail, colour vision, and anything we look at directly. It contains the highest concentration of photoreceptors (cones). When the macula is damaged by AMD, the central field of vision becomes blurred, distorted, or blank, while peripheral vision is typically preserved. People with advanced AMD cannot read, drive, or recognise faces, but they rarely become completely blind. AMD is caused by a combination of ageing, genetic factors, oxidative stress, and lifestyle factors — smoking doubles the risk and is the most important modifiable risk factor.
Dry AMD vs Wet AMD
In dry AMD, drusen (fatty deposits) accumulate under the retina, causing the macula to thin and degenerate gradually. This process, which can take years or decades, is known as geographic atrophy. There is currently no licensed treatment for dry AMD, though nutritional supplementation (AREDS2 formulation) can slow progression in certain patients. In wet AMD (also called neovascular or exudative AMD), abnormal new blood vessels grow under the retina (choroidal neovascularisation). These vessels are fragile and leaky, causing sudden distortion and rapid loss of central vision. Wet AMD can develop quickly — sometimes over days — and requires urgent treatment. Around 10–15% of people with AMD have the wet form, but it accounts for the majority of severe vision loss.
Treatment and Monitoring
Wet AMD is treated with intravitreal anti-VEGF (anti-vascular endothelial growth factor) injections directly into the eye. These drugs block the abnormal blood vessel growth, reduce leakage, and stabilise or improve vision in many patients. Ranibizumab (Lucentis) and aflibercept (Eylea) are the main NICE-approved treatments. Treatment is given as an initial course of monthly injections, followed by ongoing injections on a treat-and-extend or pro re nata (as needed) basis. For dry AMD, NICE does not recommend routine referral to hospital but advises patients to monitor for distortion or sudden worsening using an Amsler grid, and to seek urgent review if their vision changes. All AMD patients should be advised to stop smoking, eat a diet rich in leafy green vegetables, protect their eyes from UV light, and discuss AREDS2 supplements with their optometrist. This article has been prepared following careful evaluation of NICE TA155, NICE TA294, and NICE guidance on AMD.