Macular degeneration (AMD): types, self-test and treatment

Reading, recognising faces, driving: for all of these your eye relies on a small area in the centre of the retina called the macula. With age, exactly this spot can become damaged. According to the US National Eye Institute (NEI), age-related macular degeneration, or AMD for short, is one of the main causes of vision loss in older adults. First, some reassurance: AMD does not usually cause complete blindness, because vision at the edges of your visual field generally remains.

The macula: the centre of sharp vision

The macula is the central part of the light-sensitive retina and gives you sharp, straight-ahead vision – for letters, faces and fine detail. When it is damaged, a blurry, distorted or dark patch can appear right in the middle of what you are looking at, while the surroundings stay comparatively clear.

According to the NEI, the risk rises from around the age of 55. Other factors include AMD in the family, being white – and smoking, the one factor you can change yourself. Not every decline in vision later in life is AMD, though; a cataract can also cloud the picture.

Dry or wet: two forms of the disease

• Dry AMD: This affects most people with the condition. The macula gets thinner over time, and the disease usually progresses over years. It has three stages: the early stage causes no symptoms; in the intermediate stage some people notice slightly blurred central vision or difficulty seeing in low light. The late form is called geographic atrophy: retinal cells die off in defined areas.
• Wet AMD: This is less common but usually leads to vision loss more quickly. Abnormal blood vessels grow beneath the retina, and blood or fluid can leak from them – damaging the macula.

According to the NEI, any stage of dry AMD can turn into wet AMD, and the wet form is always classed as late stage.

The Amsler grid self-test

Because AMD usually develops gradually, a decline often goes unnoticed in everyday life for a long time. A simple aid is the Amsler grid: a square of grid lines with a dot in the middle. The American Academy of Ophthalmology (AAO) recommends that people with AMD use it every day. Here is how:

• Put on your reading glasses if you need them, and make sure the light is good.
• Hold the grid about 30 to 38 centimetres (12 to 15 inches) from your face.
• Cover one eye and look steadily at the centre dot with the other.
• Without moving your gaze, notice whether all the lines look straight or whether any areas appear blurry, wavy, dark or blank.
• Repeat the test with the other eye.

If you notice anything like this, the AAO advises contacting an ophthalmologist right away; the NEI likewise describes straight lines that look wavy as a warning sign of late AMD. The self-test is no substitute for a check-up, though – agree with your ophthalmologist how often you need one.

Smoking: the factor you can control

A review in the Journal of Ophthalmology (Velilla and colleagues, 2013) describes smoking as the most important modifiable risk factor for both the development and the progression of AMD. A 2010 meta-analysis cited in the review found that, depending on the type of study, current smokers had roughly 1.8 to 3.6 times the risk of AMD compared with people who had never smoked. Most studies that also recorded the amount smoked found a dose–response relationship: the more pack-years, the higher the risk.

The encouraging part: quitting pays off. According to the same review, the risk falls after stopping smoking and after about 20 years can approach that of non-smokers – although some studies still found a raised risk many years after quitting. Because smoking is also linked to the progression of the disease, quitting can be worthwhile even if you already have AMD. The NEI also recommends regular physical activity, healthy blood pressure and cholesterol levels, and a diet that includes leafy green vegetables and fish.

Treatment: what is possible today

Wet AMD: injections against abnormal blood vessels

In the wet form, a protein called VEGF (vascular endothelial growth factor) drives the growth of the abnormal vessels. Anti-VEGF medicines block this signal. According to the NEI, they are injected into the eye with a very fine needle after the eye has been numbed. Treatment can help stop bleeding and leaking from the vessels and slow vision loss. Because each dose only works for a limited time, most patients need many injections – usually monthly at first, then at intervals set individually by the doctor. Much less often, photodynamic therapy – a combination of medicine and laser – is used.

Late dry AMD: geographic atrophy

Here the picture is less clear-cut. In the USA, two medicines were approved in 2023: pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay). They are injected into the eye monthly or every other month on an ongoing basis and calm an immune response that damages retinal cells. According to the AAO, in trials they slowed the progression of geographic atrophy by about 14 to 20 per cent. Neither medicine has been shown to improve eyesight, and some patients went on to develop wet AMD. Rarely, a severe inflammation of the retinal blood vessels (retinal vasculitis) has occurred after Syfovre; according to the AAO, it can lead to permanent blindness.

In the EU the assessment was different: there, marketing authorisation for Syfovre was refused in 2024 on the recommendation of the European Medicines Agency (EMA). According to the EMA, the slower growth of the damaged areas did not bring clinically meaningful benefits in everyday life, while regular injections carry risks such as inflammation in the eye. For the second medicine (called Izelvay in the EU), the manufacturer withdrew its application in October 2024 for similar reasons. Switzerland is not part of the EU; here, authorisation decisions are made by Swissmedic. Whether these medicines can be used in Switzerland, and whether they are an option for you at all, is best discussed at an ophthalmology appointment.

Vitamins and minerals: what AREDS and AREDS2 show

Robust data on eye supplements come mainly from two large NEI studies:

• AREDS: This study of 4,757 participants aged 55 to 80 tested a high-dose combination of vitamin C (500 mg), vitamin E (400 IU), beta-carotene (15 mg), zinc (80 mg) and copper (2 mg). In people at high risk – that is, with intermediate AMD or with advanced AMD in one eye only – the risk of developing advanced AMD fell by about 25 per cent.
• AREDS2: The follow-up study with 4,203 participants tested, among other things, lutein (10 mg) and zeaxanthin (2 mg) as well as omega-3 fatty acids. Simply added to the AREDS formula, they did not lower the overall risk any further. In today’s AREDS2 formula, lutein and zeaxanthin replace beta-carotene – for two reasons: former smokers who took a formula containing beta-carotene had a higher incidence of lung cancer, and the version with lutein and zeaxanthin did slightly better than the original formula. The NEI therefore explicitly advises current and former smokers to use the version without beta-carotene.

What the studies do not show is just as important: according to the NEI, the supplements do not prevent AMD from developing in the first place, and no benefit was found in early AMD. Whether such a supplement makes sense for you therefore depends on your findings – and only an examination of the back of the eye can provide them.

What you can do

• Take warning signs seriously: wavy lines, a dark or blurry spot in the centre, or a rapid decline in vision should be checked by an ophthalmologist right away – the wet form can lead to vision loss quickly.
• Keep your family history in mind: if a parent or sibling has AMD, mention it at your next eye examination.
• If you have been diagnosed with AMD: use the Amsler grid daily, keep your follow-up appointments and only take supplements after talking to your ophthalmologist.

At our practice in Wallisellen, macula and nerve fibre measurement is part of our eye screening.