Dry Age-Related Macular Degeneration

Dry age-related macular degeneration is a common eye condition that affects central vision, particularly in people over 50. While it progresses slowly and doesn’t cause complete blindness, understanding this condition and how to manage it can help preserve your quality of life and independence.

Table of contents

• What is Dry Age-Related Macular Degeneration?
• Associated Eye Structures
• Symptoms and Warning Signs
• Stages of the Disease
• Who Is at Risk?
• How Is It Diagnosed?
• Treatment and Management
• Living with Dry AMD
• Prevention and Lifestyle Changes

What is Dry Age-Related Macular Degeneration?

Dry age-related macular degeneration, also called dry AMD or atrophic AMD, is an eye condition that causes blurred vision or reduced central vision. It happens when aging causes damage to the macula, the part of the eye that controls sharp, straight-ahead vision^[1]. The macula is part of the retina, which is the light-sensitive tissue at the back of the eye^[3].

Dry AMD is a slow deterioration of the cells of the macula, often over many years, as the retinal cells die off and are not renewed. The term “dry” does not mean the person has dry eyes—it simply means the condition is not the wet form of AMD^[2]. Nearly 90% of people with macular degeneration have the dry form^[5].

This condition develops when tiny yellow protein deposits called drusen form under your macula. The built-up deposits dry and thin your macula^[5]. It is a common condition among people over 50 and is a leading cause of vision loss for older adults^[1][3].

Almost 20 million U.S. adults have macular degeneration, and globally, the prediction is that 288 million people will have the condition by 2040^[5]. Dry AMD is the leading cause of significant visual acuity loss in people over age 50 in developed countries^[6].

Associated Eye Structures

• Macula
• Retina
• Choroid

Symptoms and Warning Signs

Macular disease affects people in different ways. The symptoms of dry AMD usually develop gradually and without pain^[1]. Early stages of dry AMD may not show any symptoms at all^[6].

Common symptoms include gaps or dark spots that may appear in your vision, like a smudge on glasses, especially first thing in the morning. You may notice visual distortions, such as straight lines seeming bent or wavy. Objects in front of you might change shape, size, or color, or seem to move or disappear^[1][2].

People with dry AMD often experience reduced central vision in one or both eyes. Colours can fade, and you may find bright light glaring and uncomfortable, or find it difficult to adapt when moving from dark to light environments^[2]. In intermediate dry AMD stages, patients may have difficulty reading in dim light or transitioning from light to dark. They may also notice a decrease in the intensity or brightness of colors^[6].

Words might disappear when you are reading, and straight lines, such as door frames and lampposts, may appear distorted or bent^[2]. Colors may also seem less bright than before, and you may have more trouble seeing in low lighting^[3].

Straight lines looking wavy is a warning sign. If you notice this symptom, see your eye doctor right away^[3].

Stages of the Disease

Dry macular degeneration has three stages. Often, symptoms like vision loss aren’t evident until the late stage, but your eye care provider can see signs when doing an exam^[5]. Dry AMD usually progresses slowly over several years^[3].

Early stage: In early stages of dry AMD, small drusen—pale-yellow lesions—form beneath the retina^[6]. Your macula changes, but vision isn’t affected. Early dry AMD doesn’t cause any symptoms^[3][5].

Intermediate stage: This stage is characterized by larger drusen. Some people still have no symptoms, while others may notice mild symptoms, like mild blurriness in their central vision or trouble seeing in low lighting. Vision may get blurry or wavy^[3][5][6].

Late stage (advanced): Areas of wasting, called atrophy, may develop in the retina. If the atrophic area is significant and has sharp borders, it is termed geographic atrophy (GA). Geographic atrophy most commonly starts in the region next to the center of the retina. Central vision fails completely in this stage^[5][6]. In the more advanced GA stage, individuals experience more marked distortion of straight lines, difficulty reading and driving at night, gradual loss of central vision, or dark, blurry areas in the center of vision^[6].

It’s important to note that around 10-15 percent of people with dry AMD go on to develop wet AMD, which is a more severe form^[2]. In some cases, the dry form can change to the wet form^[5].

Who Is at Risk?

Your risk for dry AMD increases as you get older. People age 55 and older are more likely to have AMD^[3]. As the term “age-related macular degeneration” implies, macular degeneration is more likely to occur as you get older^[5].

The strongest risk factor is age. Other important risk factors include having a family history of AMD, being Caucasian, and cigarette smoking^[3][6].

Additional risk factors include being overweight, having high blood pressure (hypertension), eating a diet high in saturated fats, being female, having high cholesterol, lower education level, sunlight exposure, light iris color, low dietary fish intake, far-sightedness, cardiovascular (heart) disease, and higher body mass index (BMI)^[5][6].

If you’re at risk for AMD because of your age, family history, or other factors, it’s important to get regular eye exams. Early AMD doesn’t have any symptoms, so don’t wait for your vision to change^[3].

How Is It Diagnosed?

The optometrist at your local optician can test sight, prescribe glasses, and check for eye disease^[2]. An eye care professional may diagnose dry macular degeneration by reviewing medical and family history and doing a complete eye exam^[9].

Several tests may be done during diagnosis:

Examination of the back of the eye: An eye doctor puts drops in the eyes to dilate them and uses a special tool to examine the back of the eye. The eye doctor looks for a mottled appearance that’s caused by yellow deposits that form under the retina, called drusen. People with macular degeneration often have many drusen^[9].

Some optometrists use photography or other imaging to detect early signs of macular degeneration. These might include optical coherence tomography (OCT) scans, which create cross-sectional images of the retina. You may be charged for these tests^[2]. For dry AMD, OCT helps track the accumulation and impact of drusen over time^[7].

Test for changes in central vision: An Amsler grid may be used to test for changes in the center of the vision field. If you have macular degeneration, some of the straight lines in the grid may look faded, broken, or distorted^[9].

Fluorescein angiography: During this test, an eye doctor injects a dye into a vein in the arm. The dye travels to and highlights the blood vessels in the eye. A special camera takes pictures as the dye travels through the blood vessels. The images may show retinal or blood vessel changes^[9].

There is currently no treatment for dry AMD, which means that you might not be referred to hospital, unless the optometrist needs to confirm their diagnosis, or thinks you need to use the hospital’s low vision service. If your sight has worsened and you want to be registered as sight impaired, you will need a hospital appointment^[2].

Treatment and Management

There is no medical treatment for dry AMD^[2]. There’s no treatment for late dry AMD, but you can find ways to make the most of your remaining vision^[3]. However, recent developments have brought new treatment options for advanced dry AMD.

In late 2023, the FDA approved new treatments for dry AMD. Pegcetacoplan, sold under the brand name Syfovre™, is a shot given inside the eye that might help slow down the worsening of geographic atrophy, a condition caused by advanced dry AMD^[12].

While there is currently no cure for dry AMD, working with an eye doctor can help manage the condition and slow its progression. Eye doctors play a key role in creating a personalized care plan that includes nutritional supplements, such as the AREDS2 formula. This formula contains vitamins C and E, zinc, copper, lutein, and zeaxanthin, which have been shown to slow the progression of dry AMD in some individuals^[7].

Treatment for dry AMD focuses mainly on lifestyle changes and dietary supplements to slow progression and support eye health. A diet high in leafy greens, colorful fruits, and foods rich in omega-3 fatty acids can support retinal function. Vitamins and nutrients play a direct role in slowing the progression of macular degeneration, making meal choices an important part of care^[7].

Regular monitoring through eye exams and imaging tests like optical coherence tomography allows for early detection of changes in the retina, enabling timely interventions^[7]. If you have dry AMD and notice a sudden change in your vision, it is important that you contact your optometrist or hospital eye specialist urgently^[2].

Living with Dry AMD

Having dry macular degeneration doesn’t mean you’ll lose all your sight. Vision loss is typically central, and people retain their side vision, also called peripheral vision^[1]. People with macular degeneration aren’t completely blind—their peripheral vision (ability to see things off to the sides) is fine^[5].

The progression of dry AMD varies, but people often carry on as normal for some time^[2]. Some people have only mild central vision loss, while in others, it can be more severe. Most people don’t completely lose central vision^[1][5].

The best way to adapt to vision loss is to learn new ways of doing things^[17]. For patients with advanced macular degeneration, low vision aids, such as magnifiers or specialized glasses, can improve daily functioning^[7]. Vision rehabilitation can help you adjust and function better with your remaining vision^[17].

Making life easier at home: Make the lighting in your home bright and even. Use task lighting to highlight what you are working on. Plain, pale decor reflects light into the room. Make the most of aids like non-slip mats, reading stands, and magnifiers. Use “talking” equipment such as microwaves, watches, scales, and timers^[18].

Use big, bright, bold, and contrasting colours to make it easier to differentiate items. For example, paint window and door frames a different colour from the walls, or walls a different colour to floors. Use different coloured chopping boards for different food types^[18].

Most people with low vision are surprised to find out how much information they can obtain from their senses of hearing, touch, and peripheral vision. Tuning into your sense of hearing in practical ways will help with daily activities^[17].

Although there’s no treatment, that doesn’t mean there’s nothing to be done. Support is available to help you live with AMD, including help with low vision and lifestyle changes^[2].

Prevention and Lifestyle Changes

While you cannot prevent dry AMD entirely, early detection and self-care measures may delay vision loss caused by dry macular degeneration^[1]. If you have AMD in one eye, the other eye may also be affected within a few years^[2].

Stop smoking: Smoking is one of the leading risk factors for macular degeneration. Quitting can slow the condition’s advancement and reduce additional damage to your vision^[21]. Smoking increases the risk of AMD, so quitting smoking is crucial^[16].

Eat a healthy diet: A diet rich in leafy green vegetables and fish can support eye health. Foods high in lutein, zeaxanthin, and antioxidants are particularly beneficial^[16]. A diet high in leafy greens, fish, and nuts can support eye health^[16].

Exercise regularly: Regular physical activity can improve overall health and potentially slow the progression of AMD^[16].

Protect your eyes from the sun: Wearing sunglasses that block harmful UV rays shield your eyes from unnecessary stress. Consistently wearing protective lenses outdoors is a small but effective step toward protecting your vision^[21].

Manage other health conditions: Control your blood pressure and cholesterol with medication or lifestyle changes. Maintaining a healthy weight, managing blood pressure, and controlling cholesterol levels are important for overall health and can positively impact eye health^[16][20].

Get regular eye exams: Routine eye exams are crucial for monitoring the progression of AMD and adjusting treatment plans as needed. Early detection of changes in vision can lead to more effective management^[16][21]. Schedule regular exams to allow tracking of changes and adjustment of your care plan as needed. Early-stage intervention is one of the most effective tools for maintaining clear vision^[21].