Age-Related Macular Degeneration (AMD)
Dry and wet types · Intravitreal injections (anti-VEGF) · Prof. Dr. Fırat Helvacıoğlu, FEBOS-CR · Veni Vidi Eye Clinic, Caddebostan – Kadıköy, Istanbul
Age-related macular degeneration is the deterioration of central vision caused by age-related damage to the macula, the centre of the retina. The dry type progresses slowly, while in the wet type, abnormal vessels leak and vision can fall rapidly. The wet type is treated with intravitreal injections (anti-VEGF); treatment started early preserves vision.
Home check: the Amsler grid
First, wearing your reading glasses, cover one eye and look at the central dot of the grid from 30–35 cm. If you notice any distortion, breaks or grey/blank areas in the lines, have an eye examination without delay.
The Amsler test does not make a diagnosis; instead, it only helps you notice changes early. Illustrative image © Prof. Dr. Fırat Helvacıoğlu
What is macular degeneration?
Age-related macular degeneration is a disease in which central vision deteriorates as the macula — the centre of the retina — is damaged with age. Tasks requiring sharp vision, such as reading, recognising faces and driving, become difficult; side (peripheral) vision is usually preserved, so the disease does not cause complete blindness.
It is one of the leading causes of serious vision loss after the age of 50 in developed countries. In addition, according to a global meta-analysis, about 8.7% of people aged 45–85 have macular degeneration.
Dry and wet types of macular degeneration
- Dry type (most patients): Deposits called drusen and pigment changes form in the macula; progression is slow. However, in the advanced stage, areas of cell loss called “geographic atrophy” may develop.
- Wet (neovascular) type: Abnormal vessels grow beneath the retina, leak and bleed. Vision can deteriorate rapidly within weeks, so it requires urgent treatment. However, the dry type can convert to the wet type at any time.
Macular degeneration: dry and wet type illustration
Shows the types of the disease in a cross-sectional (OCT-like) view of the macula.
- Healthy maculaAt the centre of the macula lies the pit that provides sharp vision (fovea), with regular layers.
- Dry type – drusenYellow deposits (drusen) form beneath the pigment epithelium; progression is usually slow.
- Dry type – geographic atrophyIn the advanced stage, areas of cell loss form in the macula; as a result, permanent central vision loss may develop.
- Wet type – new vesselsAbnormal vessels growing from the choroid leak and bleed; fluid accumulates beneath the retina. Therefore, prompt treatment is needed.
How do patients see?
How does a person with macular degeneration see?
Compare how the same scene looks with a healthy eye and with macular degeneration. Then use the slider to change the stage of the disease.
A central shadow, straight lines appearing distorted (metamorphopsia) and inability to make out faces and text are typical; side (peripheral) vision is usually preserved. However, the pattern and degree of vision loss vary from person to person. Illustrative simulation © Prof. Dr. Fırat Helvacıoğlu
Macular degeneration symptoms and risk factors
- Straight lines appearing bent or wavy (metamorphopsia)
- A grey or blank spot in the centre of the visual field
- Letters disappearing when reading; difficulty recognising faces
- Faded colours; inability to read in dim light
Risk factors: older age, smoking (the most important modifiable risk factor), a family history of macular degeneration, high blood pressure, atherosclerosis, obesity and a poor diet.
Macular degeneration treatment options
Wet type: The standard treatment is intravitreal injection of drugs that block VEGF, the substance that drives abnormal vessel growth (anti-VEGF: ranibizumab, aflibercept, bevacizumab, faricimab and similar agents). According to a Cochrane review of 16 randomised trials, anti-VEGF treatment increases the likelihood of gaining 15 or more letters of vision about fourfold. Treatment usually starts with monthly loading injections, after which the intervals are tailored individually with a “treat-and-extend” approach based on OCT findings.
Dry type: In the intermediate stage, supplements following the AREDS2 formula (containing vitamins C and E, zinc, copper, lutein and zeaxanthin) can reduce the risk of progression to the advanced stage; older formulas containing beta-carotene are not recommended for smokers. Complement-inhibitor injections that slow lesion growth in geographic atrophy have been approved in some countries; however, they have not been shown to provide a clear benefit to visual function, and their availability varies by country.
Support for people with low vision: Magnifiers, high-contrast lighting and low vision rehabilitation make daily life easier.
How is an intravitreal injection performed? The procedure is carried out under sterile operating conditions with topical anaesthesia and takes a few minutes. First, the eye and surrounding area are cleaned with an antiseptic solution, the eyelids are held open with a speculum, and the medication is injected into the eye through the white of the eye with a very fine needle. Most patients feel only slight pressure. Antibiotic drops may be used for a few days afterwards; however, if pain, increasing redness or reduced vision occur, seek medical attention immediately. Serious side effects such as infection (endophthalmitis) are rare.
Prof. Dr. Fırat Helvacıoğlu’s work
Research
With Prof. Dr. Zafer Kapran, Prof. Dr. Fırat Helvacıoğlu wrote the review chapter “Anti-VEGF therapy in age-related macular degeneration” in a special issue of the journal Retina-Vitreus (2015). The “Helvacıoğlu reproducibility index” he developed on the reliability of OCT retinal measurements also relates to the accuracy of the imaging used to monitor macular diseases.
Frequently asked questions
It does not cause complete blindness; side vision is usually preserved. However, central vision can decrease severely, and tasks such as reading and driving may become impossible.
The wet type is a chronic disease; in most patients, injection treatment continues for many years with extended intervals. Therefore, regular follow-up is the key to preserving the vision gained.
Vitamins do not prevent the disease, but in patients with intermediate disease the AREDS2 formula can reduce the risk of progression to the advanced stage. Ask your doctor which supplement is suitable for you.
Current evidence indicates that cataract surgery does not significantly worsen the disease. In addition, the macula is assessed with OCT before surgery; multifocal (trifocal) lenses are generally not recommended.
Yes, the risk of developing it in the other eye is increased. Therefore, you are advised to check your other eye regularly with the Amsler grid and not to miss your examinations.
If straight lines look wavy or you notice a spot in the centre, you should see an eye doctor without delay. The same applies to a sudden decrease in vision. In the wet type, starting treatment early is important for preserving vision.
In some patients, the dry type carries a risk of progressing to the wet type over time. For this reason, doctors recommend regular examinations and a home check with the Amsler grid.
Smoking is a known risk factor for the disease. It is also one of the most important risk factors that you can change. Eating a balanced diet and avoiding smoking support general eye health. However, on their own they do not replace treatment.
References
- Wong WL et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014;2(2):e106–e116. doi:10.1016/S2214-109X(13)70145-1
- Solomon SD et al. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev. 2019;3(3):CD005139. doi:10.1002/14651858.CD005139.pub4
- Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the AREDS2 randomized clinical trial. JAMA. 2013;309(19):2005–2015. doi:10.1001/jama.2013.4997
- Heier JS et al. Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials. Lancet. 2023;402(10411):1434–1448. doi:10.1016/S0140-6736(23)01520-9
- Kapran Z, Helvacıoğlu F. Anti-VEGF therapy in age-related macular degeneration. Retina-Vitreus. 2015;Special issue:233–243 (in Turkish).
- Helvacıoğlu F, Uyar OM, Şencan S, Tunç Z, Kapran Z. Helvacioglu reproducibility index: a new algorithm to evaluate the effects of misalignments on the measurements of retinal nerve fiber layer by spectral-domain OCT. Int J Ophthalmol. 2015;8(5). doi:10.3980/j.issn.2222-3959.2015.05.28
This page is intended for patient information and does not replace an examination or medical assessment. The treatment that is right for you is determined after an eye examination and measurements.
Macular examination and OCT
Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Caddesi No: 257, Caddebostan – Kadıköy, Istanbul, Türkiye
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