Dry AMD (dry age-related macular degeneration): symptoms and management

The macula is a tiny area at the centre of the retina that lets you see fine detail when you look straight ahead. The NHS describes age-related macular degeneration (AMD) as a common condition that affects the middle part of vision and usually first appears in people in their 50s. NICE Clinical Knowledge Summaries defines it as changes in the macula without another obvious cause in people aged 50 and over.

AMD is described as early or late. RNIB explains that early AMD often causes no symptoms and is picked up at a routine eye test, when the optometrist sees medium or large drusen, small yellow deposits under the retina. Small drusen can be a normal part of ageing and are not always a sign of AMD. Late AMD has two main types, dry and wet. The names refer to what happens inside the eye, not to dry or watery eyes.

In dry AMD, cells at the macula degenerate and stop working. RNIB says this usually takes a long time to reach its final stage, which is called geographic atrophy and produces a dark or missing area in the centre of vision. NICE CKS describes geographic atrophy as a breakdown of light-sensitive cells that forms sharply defined areas of atrophy which can enlarge over time and tend to progress slowly.

The first symptom is often a blurred or distorted area in the centre of vision, according to the NHS. RNIB adds that people often find it harder to see detail such as small print, and may be more sensitive to bright light. NICE CKS also lists difficulty adjusting from bright to dim lighting, a black or grey patch in the central field and flickering or flashing lights.

AMD is not painful and does not change how the eyes look. Because it can affect one eye first, the other eye may compensate, and RNIB notes that you might not notice blurring in the early stages. That is one reason regular eye tests are valuable.

Some people with significant sight loss see shapes, colours or figures that are not there. RNIB explains that this is Charles Bonnet syndrome, that the images are silent, and that people know what they are seeing is not real. It is worth mentioning to your eye team if it happens.

• See an optician if you are worried about your vision. The NHS notes early diagnosis and treatment may help stop sight getting worse.

• Get an urgent optician appointment or call NHS 111 if vision suddenly gets worse, a dark curtain or shadow moves across your vision, or your eye is red and painful.

• RNIB advises seeing the optometrist straight away if you notice quick changes to your vision.

The exact cause of AMD is unknown. The NHS says it has been linked to ageing, smoking, high blood pressure, being overweight and a family history. NICE CKS lists established risk factors as older age, smoking, a family history of AMD and genetic factors.

Of these, smoking is the one that appears in both lists and is within a person's control. High blood pressure and being overweight are also named by the NHS. Neither source claims that any single lifestyle change will stop dry AMD progressing, so these are sensible general health steps rather than a treatment.

Most people first hear about AMD from an optometrist. RNIB says that if you have early or dry AMD you will usually be monitored by your optometrist, who will say how often to return, perhaps every year or two. Between visits you may be advised to check each eye separately against straight lines at home, and some optometrists provide an Amsler grid, a paper test for this.

RNIB sets out when an optometrist refers to a hospital eye clinic. Suspected wet AMD leads to a quick referral, and you should expect to be seen within two weeks. People with dry AMD whose vision has worsened to a stage where they could be certified with sight loss are referred routinely. NICE CKS gives the primary care standard for suspected neovascular (wet) AMD as urgent referral within one working day.

At the eye clinic, care is led by a consultant ophthalmologist. If there are no signs of wet AMD, RNIB says you will usually be discharged back to your optometrist for regular monitoring, and that you should keep attending eye tests and report any change in between.

The NHS says there is no cure for AMD but support is available to slow the changes and help quality of life, and that there is currently no treatment for dry AMD. It lists help with low vision and lifestyle changes as the main support and notes research into new treatments is ongoing, so specialists can tell you about studies.

RNIB mentions some evidence that a specific combination of antioxidant vitamins and minerals may help slow worsening in some people at high risk of progression, and says your optometrist can advise whether a supplement is likely to help you. It is not a general recommendation for everyone with early changes, so ask before buying anything.

Wet AMD is different. RNIB explains that treatment with anti-VEGF injections stops new blood vessels growing and usually needs to be given quickly, before scarring causes permanent damage. The usual start is one injection a month for three months, then further treatment depending on the drug and response. The NHS also mentions light treatment to destroy vessels. This is why a change in a person with dry AMD should never be left to see if it settles.

RNIB stresses that AMD only affects central vision and not peripheral vision, so people can usually still get around independently. Changes in central vision are permanent and cannot be fully corrected with new glasses, but most people keep some useful sight. Making things bigger, using brighter lighting and using colour contrast can all help.

A low vision assessment can explore magnifiers, aids and techniques such as eccentric viewing, where you read using an area of side vision. Your optometrist or eye clinic can arrange it. Many hospital eye clinics also have an eye care liaison officer offering practical and emotional support, and the Macular Society runs local groups and a counselling service, RNIB says.

You are required by law to tell the DVLA if an eye condition affects both eyes, and RNIB advises asking your optometrist or ophthalmologist whether your sight meets the driving standards. NICE CKS lists depression, falls and fractures among the possible complications of AMD, a reminder that emotional wellbeing and home safety deserve attention alongside vision itself.

Eye tests, monitoring by an optometrist and hospital eye clinic care, including injections for wet AMD, are available through the NHS. For dry AMD the main NHS offering is monitoring plus low vision support, because no treatment is available.

Seeing a private retina specialist is mainly useful for a second opinion, quicker access to imaging such as optical coherence tomography, or a clearer explanation of your stage. It does not change the underlying position that there is no established treatment for dry AMD. If symptoms suggest wet AMD, do not wait for a private appointment: use the urgent NHS route first.