Age-related macular degeneration

Age-related macular degeneration (AMD) is a potentially progressive maculopathy that affects older adults and can lead to severe visual impairment and blindness.

AMD is categorised into early, intermediate, or late disease (neovascular AMD or geographic atrophy), depending on the number and size of drusen and the presence of pigmentary changes, geographic atrophy, or macular neovascularisation (MNV).

Patients with early AMD may have no visual changes while patients with neovascular AMD often present with rapid-onset of blurring or distortion of vision.

Optical coherence tomography is the most widely used imaging modality for diagnosing and managing AMD.

Treatment depends on the category of AMD; patients with intermediate or late AMD are likely to require consultation with a retinal specialist.

AMD is a potentially progressive maculopathy.[1]Arnold JJ. Age-related macular degeneration: anti-vascular endothelial growth factor treatment. BMJ Clin Evid. 2016 Feb 24;2016:0701. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765776 http://www.ncbi.nlm.nih.gov/pubmed/26909890?tool=bestpractice.com Early and intermediate AMD involve drusen (yellow deposits under the retina made up of lipids and proteins) and macular pigmentary changes, and are usually associated with normal or gradually reducing vision. Late (or advanced) AMD is associated with a more significant decrease or loss of central vision and has two forms: geographic atrophy (or 'atrophic' or 'dry' AMD) and neovascular AMD (or 'wet' or 'exudative' AMD).[2]Ferris FL 3rd, Wilkinson CP, Bird A, et al; Beckman Initiative for Macular Research Classification Committee. Clinical classification of age-related macular degeneration. Ophthalmology. 2013 Apr;120(4):844-51. http://www.ncbi.nlm.nih.gov/pubmed/23332590?tool=bestpractice.com Geographic atrophy is a chronic progressive degeneration of the macula; degeneration commences at the level of the retinal pigment epithelium, which is lost in the late stages with associated thinning and degeneration of the neurosensory retina. Neovascular AMD involves MNV, the abnormal growth of blood vessels within the macula.[3]Sheth JU, Stewart MW, Narayanan R, et al. Macular neovascularization. Surv Ophthalmol. 2025 Jul-Aug;70(4):653-75. http://www.ncbi.nlm.nih.gov/pubmed/39222802?tool=bestpractice.com

People with small drusen (<63 micrometres), also termed drupelets, are considered to have normal ageing changes. People with mainly small and few intermediate-sized drusen (≥63 to <125 micrometres) in the absence of pigmentary changes are defined as having early AMD. People with extensive intermediate drusen, at least one large drusen (≥125 micrometres), or pigmentary abnormalities and at least intermediate-sized drusen are defined as having intermediate AMD.[2]Ferris FL 3rd, Wilkinson CP, Bird A, et al; Beckman Initiative for Macular Research Classification Committee. Clinical classification of age-related macular degeneration. Ophthalmology. 2013 Apr;120(4):844-51. http://www.ncbi.nlm.nih.gov/pubmed/23332590?tool=bestpractice.com [4]American Academy of Ophthalmology. Age-related macular degeneration preferred practice pattern 2024. Feb 2025 [internet publication]. https://www.aao.org/education/preferred-practice-pattern/age-related-macular-degeneration-ppp ​​