Stages of AMD

Stages of Age-Related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) usually develops slowly, in stages. Nearly 20 million Americans age 40 and older have AMD,¹ and it is the leading cause of blindness in people 55 and older in developed countries.²

AMD affects the macula, the small area at the center of the retina that lets you read, recognize faces and see fine detail. Knowing which stage you or a loved one is in can help you understand what to expect, what to watch for and which questions to ask your eye doctor.

Most people with AMD start with the dry form. For many, it never causes serious vision loss. For some, it progresses to an advanced stage: geographic atrophy (advanced dry AMD), wet AMD, or both.

AMD Stages at a Glance

Use this chart to find the stage that matches your diagnosis, then read more in the sections below.

What are drusen?

Drusen are tiny yellow deposits of fat and protein that build up under the retina. Many people develop small drusen as they age, and most never cause vision problems or indicate AMD on their own.

The size and number of drusen matter. Medium-sized drusen characterize early AMD. Large drusen, or certain pigment changes associated with AMD, indicate intermediate AMD and a higher risk of progression to advanced disease. Symptoms: Drusen usually cause no symptoms. Most people learn they have them during a dilated eye exam.

What you can do:

• Keep up with regular dilated eye exams so your doctor can track any changes.
• Ask whether your drusen are small, medium or large, and whether they are a sign of AMD.
• If you smoke, quitting is one of the most important steps you can take to protect your vision.

Questions to ask your eye doctor:

• What size are my drusen, and how many do I have?
• Do I have AMD, or just drusen?
• How often should I come back for an exam?

What is dry AMD?

Dry AMD is the most common form of AMD, accounting for about 85 to 90 percent of cases.³ It develops when drusen build up under the macula and the cells that support central vision slowly begin to wear down.

Doctors describe dry AMD in stages:

• Early dry AMD: Medium-sized drusen are present. Most people have no symptoms.
• Intermediate dry AMD: Drusen are larger, or there are changes in the pigment of the retina. Some people notice mild blurriness or have trouble seeing in low light.
• Geographic atrophy is the advanced stage of dry AMD, described below.

If one eye has AMD, the other eye often has it too or is at risk of developing it.

Symptoms:

• No symptoms in the early stage
• Mild blur in central vision during tasks like reading
• Needing more light to read or see detail
• Slower adjustment when moving from bright to dim light

What you can do:

• Keep regular eye exams. Your doctor can spot changes before you notice them.
• Monitor your vision at home. Your doctor may suggest an Amsler grid or another home monitoring tool to catch changes early.
• Ask about AREDS2-formula supplements. The National Eye Institute's Age-Related Eye Disease Studies found that a specific combination of vitamins and minerals can slow progression of intermediate AMD to advanced AMD for people at higher risk. See the Treatments page for details.
• Protect your eyes and health. Don't smoke, eat a diet rich in leafy greens and fish, and wear sunglasses outdoors.

Questions to ask your eye doctor:

• Is my AMD early or intermediate?
• Should I take an AREDS2-formula supplement?
• How should I monitor my vision at home, and what changes should prompt a call?
• What is my risk of developing advanced AMD?

What is geographic atrophy (GA)?

Geographic atrophy (GA) is the advanced form of dry AMD. In GA, the retinal pigment epithelium (RPE), a layer of cells that supports the light-sensing photoreceptors, breaks down in patches. As those support cells are lost, photoreceptors die and central vision fades in those areas.

The damaged areas, called lesions, slowly grow over time. That is why vision loss from GA is gradual but ongoing. Researchers have found that part of the immune system, called the complement system, may be overactive in people with AMD and play a role in this damage.

Symptoms:

• Blind spots (scotomas) in or near the center of your vision
• Blind spots that slowly grow larger
• Difficulty reading, driving or recognizing faces
• Colors that look duller
• Trouble seeing in dim light

What you can do:

• See a retinal specialist. Two FDA-approved treatments, SYFOVRE and IZERVAY, can slow the growth of GA lesions. They do not restore lost vision, so starting the conversation early matters. See the Treatments page for details.
• Explore clinical trials. Gene therapies, cell therapies and new drugs for GA are being tested now. Visit the Foundation's Clinical Trial Pipeline.
• Use low vision tools. Magnifiers, lighting and technology can make daily tasks easier. See Low Vision Resources.

Questions to ask your retinal specialist:

• How quickly are my GA lesions growing?
• Am I a candidate for SYFOVRE or IZERVAY?
• What are the benefits, risks and time commitment of treatment?
• Are there clinical trials I might qualify for?

What is wet AMD?

Wet AMD, also called neovascular AMD, is an advanced form of AMD. It happens when abnormal blood vessels grow under the macula and leak fluid or blood, which can quickly damage the cells that provide central vision.

About 10 to 15 percent of people with dry AMD develop wet AMD.³ Wet AMD can progress quickly, but treatments available today can help many people preserve their vision, especially when started early. Some people have both wet AMD and geographic atrophy.

Symptoms:

• Straight lines that look wavy or bent
• A sudden blur or dark spot in central vision
• Rapid changes in how well you see detail

If you notice sudden changes in your vision, contact your eye doctor right away.

What you can do:

• See a retinal specialist promptly. Most treatments are injections into the eye that block the growth of leaky blood vessels. Newer options last longer between visits. See the Treatments page for details.
• Stay on schedule. Regular treatment visits are key to protecting your vision.
• Watch for research advances. Gene therapies that could reduce the need for frequent injections are in late-stage clinical trials.

Questions to ask your retinal specialist:

• Which treatment do you recommend for me, and how often will I need it?
• What should I do if I notice new changes between visits?
• Is my other eye at risk?
• Am I a candidate for a longer-lasting treatment or a clinical trial?

Who is at risk for AMD?

Age is the biggest risk factor for AMD, and smoking is the most important one you can change. The same risk factors apply at every stage. Family history, genetics and diet also influence risk.

Having a genetic risk does not mean you will get AMD, and people with low genetic risk can still develop it. Regular eye exams are the best way to catch changes early.

Frequently asked questions

Is AMD the same as macular degeneration? Yes. Age-related macular degeneration is the full name, and many people simply call it macular degeneration. Some rarer macular diseases, such as Stargardt disease, affect younger people and have different causes.

What is the difference between dry AMD and wet AMD? Dry AMD is caused by drusen buildup and the slow breakdown of retinal cells. Wet AMD is caused by abnormal blood vessels that leak under the retina. Dry AMD is far more common and usually progresses slowly. Wet AMD can progress quickly but has several approved treatments.

Does having drusen mean I have AMD? Not necessarily. Small drusen are common with age and often harmless. Medium and large drusen are a sign of AMD. Your eye doctor can tell you which type you have.

Can dry AMD turn into wet AMD? Yes. About 10 to 15 percent of people with dry AMD develop wet AMD.³ Watch for sudden changes, such as straight lines looking wavy, and contact your doctor right away if you notice them.

Will I go blind from AMD? AMD affects central vision, the sharp, detailed vision you use to read and recognize faces. Advanced AMD can cause serious central vision loss, but side (peripheral) vision usually remains. Many people with AMD keep useful vision for years, and treatments and low vision tools can help.

Is there a treatment for geographic atrophy? Yes. In 2023, the FDA approved SYFOVRE and IZERVAY, the first treatments for GA.⁴ Both slow the growth of GA lesions but do not restore lost vision. More therapies are in clinical trials.

What is the difference between AREDS2 and AREDS3? AREDS2 is the vitamin and mineral formula tested by the National Eye Institute and shown to slow progression to advanced AMD in people at higher risk. "AREDS3" is not a new National Eye Institute study or formula. It is a product name used by one brand for a supplement that combines the AREDS2 nutrients with added B vitamins. Ask your eye doctor which supplement, if any, is right for you.

Can AMD affect both eyes? Yes. AMD often affects both eyes, though it may progress at different rates in each. If one eye has AMD, the other is at higher risk.

How is AMD diagnosed? AMD is diagnosed during a dilated eye exam. Your doctor may also use imaging tests, such as optical coherence tomography (OCT), to see the layers of the retina and track changes over time.

The information provided by the Foundation Fighting Blindness is for educational purposes only and is not intended as medical advice. Some of the information provided has been obtained from widely used third-party public sources, but the Foundation is unable to independently verify the accuracy of all of such information. The Foundation does not endorse any specific treatment, product, clinical trial, company, or provider, including those mentioned in our content or featured through our partners and sponsors. Every person's condition is unique. Please talk with your qualified eye care professional about the treatment options that are right for you.