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Health condition · Clinically reviewed

Age-related macular degeneration, from drusen to anti-VEGF - and everything in between.

AMD is the leading cause of severe sight loss in older UK adults - but modern injections, supplements and new complement inhibitors have transformed what treatment can do.

Jump to treatment
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, Royal College of Ophthalmologists and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including anti-VEGF regimens, faricimab and new GA therapies.

Key facts

AMD at a glance.

The essentials, in plain English - what AMD is, the four stages, and how it is investigated and treated in the UK today.

  • What it is

    A progressive disease of the macula, the central part of the retina, causing gradual or sudden loss of central vision.

  • Why it matters

    The leading cause of severe sight loss in people over 65 in the UK, affecting around 700,000 people.

  • Two main forms

    Dry AMD (about 90 percent of cases, slow) and neovascular or wet AMD (about 10 percent, rapid and sight-threatening).

  • Key symptom

    Straight lines appearing wavy on an Amsler grid (metamorphopsia) and a blurred or missing central spot.

  • Gold-standard test

    Optical coherence tomography (OCT), often with OCT-angiography, to visualise the retinal layers and new vessels.

  • Foundation therapy

    Intravitreal anti-VEGF injections for wet AMD, AREDS2 supplements for intermediate dry AMD, and new complement inhibitors for geographic atrophy.

Why this guide matters

Four stages, two very different treatment paths.

Understanding whether you have early, intermediate, geographic atrophy or wet AMD sets everything that follows - from supplements to injections.

  • Wet AMD is time-critical

    New distortion or a sudden central blur can be treated - but only if anti-VEGF starts within days, not months.

  • Dry AMD is manageable, not passive

    AREDS2 supplements, Mediterranean diet and stopping smoking meaningfully slow progression to advanced disease.

  • Geographic atrophy has options now

    For the first time, complement inhibitors like pegcetacoplan can slow GA lesion growth - a shift in what dry AMD care looks like.

How the diagnosis is made

From first blur to a clear treatment plan.

The steps a UK optometrist and hospital eye service will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Symptom history and vision test

    Central blur, distortion or a missing spot, plus a Snellen visual acuity check in each eye separately.

  2. 02

    Assessing

    Amsler grid screening

    A grid used at home and in clinic to detect wavy lines or missing squares that suggest active wet AMD.

  3. 03

    Assessing

    Dilated fundus examination

    An ophthalmologist looks for drusen, pigment change, atrophy, haemorrhage or fluid at the macula.

  4. 04

    Confirming

    Optical coherence tomography

    OCT is the gold standard, giving cross-sectional images of the retina to grade drusen, atrophy and fluid.

  5. 05

    Confirming

    OCT-angiography

    A non-invasive scan that maps the retinal and choroidal vasculature to detect choroidal neovascularisation.

  6. 06

    Confirming

    Fundus autofluorescence

    Highlights areas of geographic atrophy and helps track progression over time.

  7. 07

    Planning

    Fluorescein angiography (select)

    Occasionally used when OCT-A is inconclusive, to characterise the type of neovascular membrane.

Typical timeline: optometry to hospital eye service in days for suspected wet AMD.

Symptoms

What AMD actually looks like.

Central blur, wavy lines and a missing spot - the classic signs, plus the changes on OCT and fundus imaging that guide treatment.

  • Drusen

    Small, medium or large yellow deposits under the retina, the earliest hallmark of dry AMD.

  • Pigmentary change

    Areas of increased or decreased pigment at the macula, marking retinal pigment epithelium dysfunction.

  • Geographic atrophy

    Well-demarcated patches of RPE and photoreceptor loss, the late stage of dry AMD.

  • Metamorphopsia

    Straight lines appear wavy, bent or broken on the Amsler grid, a classic early sign of wet AMD.

  • Central scotoma

    A blurred or blank spot in the centre of vision that makes reading and recognising faces difficult.

  • Sudden vision loss

    A rapid drop in central vision over days to weeks strongly suggests choroidal neovascularisation.

  • Colour and contrast loss

    Colours can look washed out and contrast reduces, often before acuity changes noticeably.

  • Red flag - sudden distortion

    New wavy lines or a sudden blur in one eye is a same-week emergency referral for possible wet AMD.

Treatment

How AMD is treated in the UK.

Lifestyle and AREDS2 for dry AMD, intravitreal anti-VEGF for wet AMD, and new complement inhibitors for geographic atrophy.

  • AREDS2 supplements

    Vitamin C and E, zinc, copper, lutein and zeaxanthin - reduce progression of intermediate dry AMD by about 25 percent at five years.

  • Smoking cessation

    Smoking doubles the risk of progression and blunts treatment response - stopping is the single biggest lifestyle lever.

  • Mediterranean diet

    Rich in oily fish, leafy greens, olive oil and nuts - associated with slower progression in multiple cohort studies.

  • Ranibizumab (Lucentis)

    Intravitreal anti-VEGF injection for wet AMD, given monthly then extended - NICE TA155 approves it on the NHS.

  • Aflibercept (Eylea, Eylea 8 mg)

    Anti-VEGF injection with longer dosing intervals, including a high-dose 8 mg formulation - NICE TA294 approves it for wet AMD.

  • Faricimab (Vabysmo)

    A bispecific antibody blocking both angiopoietin-2 and VEGF-A, often allowing dosing every 12 to 16 weeks.

  • Pegcetacoplan / avacincaptad

    Intravitreal complement inhibitors (Syfovre and Izervay) - the first approved treatments to slow geographic atrophy, licensed in the US in 2023.

  • Low vision rehabilitation

    Magnifiers, high-contrast lighting, eccentric viewing training and registration as sight impaired - independence when medicine has done its part.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and landmark trials, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your optometrist or ophthalmologist knows your eyes and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Age-related macular degeneration: diagnosis and management (NG82).

  • NICE TA294. Aflibercept solution for injection for treating wet AMD.

  • NICE TA155. Ranibizumab and pegaptanib for the treatment of AMD.

  • Royal College of Ophthalmologists. AMD guidelines (2022).

  • AREDS2 Research Group. NEJM and JAMA Ophthalmology publications.

  • Macular Society. Patient information on dry and wet AMD.

Red flags

When AMD needs urgent attention.

Some AMD symptoms need same-week, same-day or emergency assessment. These are the ones we do not sit on.

  • Sudden central distortion

    New wavy lines, a dark spot or a rapid blur in one eye needs a same-week hospital eye service referral for suspected wet AMD.

  • Sudden painless vision loss

    A rapid drop in central vision over hours to days is an ophthalmic emergency until proven otherwise.

  • Flashes, floaters or a curtain

    These suggest retinal detachment or vitreous haemorrhage rather than AMD - urgent same-day assessment.

  • Fellow-eye change with known AMD

    People with wet AMD in one eye have a high risk in the other - any new symptom warrants urgent review.

  • Injection-related pain or redness

    Endophthalmitis after an intravitreal injection is rare but sight-threatening - contact the injecting team immediately.

  • Mood and isolation

    Sight loss is strongly linked with depression - low mood or withdrawal deserves compassionate support and referral.

  • Falls and mobility loss

    Central vision loss increases fall risk - occupational therapy and home-safety review help protect independence.

  • Missed injection appointments

    Wet AMD responds to treatment only while therapy continues - even short delays can cause permanent vision loss.

  • Other retinal disease

    Diabetic macular oedema, retinal vein occlusion and myopic CNV can mimic AMD - specialist imaging distinguishes them.

Living with it

A long-term condition, with real levers.

Four habits that make the biggest day-to-day difference - self-monitoring, healthy lifestyle, keeping every injection, and asking for practical support.

A quiet reminder

Sight loss is not the same as helplessness.

Low vision services, technology and rehabilitation can preserve independence and confidence long after central vision has changed.

  1. 01 Monitor

    Use your Amsler grid weekly

    Test one eye at a time, at reading distance, in good light - and report any new distortion the same week.

  2. 02 Lifestyle

    Stop smoking, eat Mediterranean

    The two lifestyle changes with the strongest evidence for slowing dry AMD and improving wet AMD outcomes.

  3. 03 Adherence

    Keep every injection appointment

    Anti-VEGF works only while it is being given - missed visits are the commonest reason for vision loss on treatment.

  4. 04 Support

    Ask for low vision help early

    Magnifiers, lighting changes and sight-impairment registration open doors to benefits, aids and rehabilitation.

Frequently asked

Everything we get asked about AMD.

Quick answers on dry versus wet AMD, OCT, injections, AREDS2 and geographic atrophy.

  • What is age-related macular degeneration?

    A progressive disease affecting the macula, the small central area of the retina responsible for sharp, detailed vision. It is the leading cause of severe sight loss in people over 65 in the UK and comes in dry and wet forms.

  • What is the difference between dry and wet AMD?

    Dry AMD is a slow process of drusen build-up, pigment change and eventually geographic atrophy. Wet AMD (neovascular AMD) is caused by abnormal new blood vessels growing from the choroid that leak and bleed, causing rapid central vision loss and distortion. About 90 percent of AMD is dry, but wet AMD causes the majority of severe sight loss.

  • How is AMD diagnosed?

    Through a dilated fundus examination and optical coherence tomography (OCT), which is the gold-standard imaging test. OCT-angiography, fundus autofluorescence and occasionally fluorescein angiography add further detail, and an Amsler grid is used at home for monitoring.

  • Can AMD be treated?

    Yes. Wet AMD is treated with intravitreal anti-VEGF injections such as ranibizumab, aflibercept and faricimab, often for life. Intermediate dry AMD is slowed by AREDS2 supplements, and new complement inhibitors (pegcetacoplan and avacincaptad) are the first treatments licensed to slow geographic atrophy.

  • Do AREDS2 supplements really work?

    The AREDS2 formulation reduces the risk of progression from intermediate dry AMD to advanced AMD by around 25 percent over five years. They are recommended for intermediate dry AMD or advanced AMD in one eye, but not for early AMD or as a preventive measure in people with healthy eyes.

  • How often will I need anti-VEGF injections?

    Most people start with three monthly loading doses, then move to a treat-and-extend or personalised schedule with intervals of 8 to 16 weeks. Faricimab and high-dose aflibercept often allow the longest intervals. Injections are usually needed indefinitely - stopping causes the disease to reactivate in most people.

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