Macular Degeneration: Symptoms, Types, Treatment and Integrative Support

Age-related macular degeneration (AMD) is an eye disease that damages the macula, the small central part of the retina that gives you sharp, straight-ahead vision¹. It blurs or distorts central vision but leaves side vision intact². In 2019 about 20 million Americans aged 40 and older had AMD, including about 1.5 million with the late, vision-threatening stage^3,4. That estimate left out people with only the mildest changes, so the number with any sign of AMD is higher³. It is a leading cause of vision loss in people over 50². There is no cure, but there is real treatment⁴. Injections protect and often improve vision in wet AMD, vitamins lower the risk of progression for people with intermediate disease, and in 2023 the first drugs that slow late dry AMD were approved^4,5. Central vision loss is common in late AMD, but total blindness is extremely rare⁴.

This page explains the types and stages of AMD, the symptoms that need urgent attention, and who is at risk. It covers diagnosis and monitoring, what treatment can and cannot do today, and the new treatments in late-stage trials. It ends with where integrative care can and cannot fit alongside your retina specialist.

Macular degeneration at a glance

On this page

• What is macular degeneration?
• Symptoms
• Causes and risk factors
• Diagnosis
• Treatment today
• New treatments in clinical trials
• Living with macular degeneration
• Where integrative care fits
• Outlook
• Frequently asked questions
• Sources

What is macular degeneration?

The retina is the light-sensing layer at the back of the eye, and the macula is its centre: the part you use to read, drive and recognise faces¹. In AMD, ageing damages the macula¹. Yellow deposits called drusen build up under the retina, and in later stages patches of retinal cells die or abnormal blood vessels grow and leak^2,4.

There are two main types^1,2:

• Dry AMD is the common form; most people with AMD have it¹. The macula thins and drusen build up. It usually progresses slowly over years, through early, intermediate and late stages¹. Late dry AMD is called geographic atrophy: patches where retinal cells have died, which grow by about 1.3 to 2.6 square millimetres a year⁴.
• Wet AMD (neovascular AMD) is a late stage in which abnormal blood vessels grow under the retina and leak fluid or blood, scarring the macula². Any stage of dry AMD can turn into wet AMD¹. It is less common but causes most of the severe vision loss from AMD^1,7,8. In a 1984 report, from before today's treatments, 79% and 90% of eyes that were legally blind from AMD had wet AMD⁷. Vision can be lost quickly without treatment².

Eye doctors stage AMD by the size of the drusen and changes in the retina's pigment¹³:

• Early AMD: medium drusen. In AREDS, only about 1% of people with early AMD reached the late stage within five years^13,4.
• Intermediate AMD: large drusen, or changes in the retina's pigment layer together with medium drusen. The five-year risk of late AMD ranges from about 3% to about 50%, depending on whether there are large drusen and pigment changes in one eye or both^13,14.
• Late AMD: geographic atrophy, wet AMD, or both¹³.

Our guide to wet vs dry macular degeneration and the stages of AMD explains drusen and staging in more detail.

Symptoms of macular degeneration

Early AMD usually causes no symptoms¹. In intermediate AMD some people still notice nothing, while others have mild blurring in the centre of their vision or trouble seeing in low light¹. In late AMD, wet or dry, people commonly notice¹:

• straight lines that look wavy or bent
• a blurry area near the centre of vision, which can grow or become a blank spot
• colours that look less bright
• more difficulty seeing in dim light

Sudden distortion or a new dark spot: call your eye doctor right away

New distortion, a new blurry or dark patch, or a sudden drop in central vision can mean wet AMD, which needs prompt examination^1,4. Early detection and prompt treatment of wet AMD improves vision outcomes⁴. Do not wait for your next routine appointment.

Checking at home with an Amsler grid

The American Academy of Ophthalmology advises people with AMD to use an Amsler grid, a printed square of straight lines with a dot in the centre, every day². In good light, hold it 12 to 15 inches away, wear your reading glasses, cover one eye and look at the central dot. Note any lines that look wavy, blurry, dim or missing, then repeat with the other eye. Call your ophthalmologist right away if anything has changed². Our guide to what macular degeneration vision looks like describes the early changes people notice.

Seeing things that are not there

Some people with AMD see vivid images, patterns or faces that are not there. This is called Charles Bonnet syndrome. In studies of people with AMD seen in eye clinics and low vision services, about 1 in 6 had experienced it. The share ranged from about 1 in 14 in wet AMD clinics to nearly 1 in 3 at low vision centres¹⁵. It is a result of vision loss, not a sign of psychosis or mental decline, and doctors advise explaining it to both patients and their families⁴.

What causes macular degeneration, and who is at risk?

Age is the main risk factor: in one large study, 4% of people aged 43 to 54 developed AMD over ten years, against 46% of those aged 75 and older⁴. Other risks include^4,9:

• Smoking. The main risk you can change. Current smokers have two to three times the risk of never-smokers¹⁶. Risk falls after quitting; people who had not smoked for more than 20 years had a risk similar to non-smokers¹⁷.
• Family history and genes. Having a close relative with AMD roughly doubles the risk¹⁸. Common variants in immune-system genes such as CFH (complement factor H) raise risk; one copy of the main CFH variant about doubles the risk of late AMD in people of European ancestry¹⁹. Routine genetic testing is not recommended: it adds little to the risk estimate from an eye examination, and it is not needed to decide on vitamins⁴. Our guide answers is macular degeneration hereditary?
• Ancestry. Late AMD is more common in people of European ancestry than in people of African or Hispanic ancestry^4,6.
• Heart and metabolic health. Higher body weight, heart disease and high blood pressure were linked with late AMD in a pooled analysis⁹, although studies disagree about blood pressure and heart disease⁴.
• Previous cataract surgery is associated with late AMD in pooled studies⁹. This is an association, not proof that surgery causes AMD.
• Diet. A diet low in leafy greens and fish and high in saturated fat is linked to higher risk (see "Where integrative care fits" below)^4,20.

How macular degeneration is diagnosed

AMD is diagnosed in a dilated eye examination, in which the doctor looks for drusen, pigment changes, atrophy and signs of fluid or bleeding^1,4. Tests that confirm the stage and guide treatment include^2,4:

• Optical coherence tomography (OCT), a scan that shows the retina's layers and detects fluid under or within the retina; it is central to managing wet AMD⁴.
• OCT angiography, which shows abnormal blood vessels without a dye².
• Fluorescein angiography, a dye test that shows leaking vessels².
• Fundus autofluorescence, an image that maps geographic atrophy and its growth⁴.

Our guide to macular degeneration tests: Amsler grid, OCT and imaging explains what each scan shows.

Home monitoring

Two FDA-cleared or authorised home devices can add to, but not replace, clinic visits. ForeseeHome, a vision-testing device, was cleared by the FDA in 2009. In a randomised trial of 1,520 people at high risk of wet AMD, 82 developed it during the study. Those using the device had lost a median of 4 letters on the eye chart by the time it was found, against 9 letters with usual care²¹. The Notal Vision Home OCT, authorised in 2024, lets people already diagnosed with wet AMD scan their own retina between visits. It is a prescription device, and the FDA says it is not intended for making treatment decisions or replacing clinic examinations and scans¹¹.

How often to be checked

If there are no new symptoms, the American Academy of Ophthalmology recommends a follow-up examination every 6 to 24 months for early AMD and every 6 to 18 months for intermediate AMD. Any new symptom needs a prompt examination⁴. People with wet AMD on injections are seen about every four weeks at first⁴.

Diagnosis, staging, scans and injection decisions belong with your ophthalmologist or retina specialist, and we ask every patient to keep that care in place.

Macular degeneration treatment today

There is no cure for AMD. Treatment depends on the type and stage⁴.

AREDS2 vitamins for intermediate AMD

Two large National Eye Institute trials, AREDS and AREDS2, tested high-dose vitamins and minerals. In people with intermediate AMD, or late AMD in one eye, the original AREDS formula lowered the risk of progressing to late AMD by about 25% over five years^22,23. AREDS2 then showed that replacing its beta-carotene with lutein and zeaxanthin worked at least as well, without beta-carotene's lung-cancer risk^24,25. In absolute terms, about 78 fewer people out of every 1,000 with higher-risk intermediate AMD progressed²⁶. The supplements did not help people with early AMD or without AMD, and they do not prevent AMD^22,4. There is no evidence that they help family members who have no signs of the disease⁴.

The daily AREDS2 formula is vitamin C 500 mg, vitamin E 400 IU, lutein 10 mg, zeaxanthin 2 mg, zinc 80 mg (a 25 mg dose worked as well) and copper 2 mg^27,4,22. Retail labels may show different numbers because of FDA labelling rules, so check with your eye doctor⁴. The original AREDS formula used beta-carotene instead of lutein and zeaxanthin; beta-carotene nearly doubled the risk of lung cancer, mostly in former smokers, so current and former smokers should use the AREDS2 formula^24,25,27. Adding fish-oil omega-3 to the formula did not help²⁴. In AREDS, high-dose zinc was linked to more hospital stays for urinary problems, and the formula can change how other medicines work, so review it with your primary care doctor^4,27. Our guide to macular degeneration vitamins and diet goes further.

Eye injections for wet AMD

Anti-VEGF injections are the first-line treatment for wet AMD⁴. They block a signal, VEGF, that makes the abnormal blood vessels grow and leak²⁸. At first most people need an injection about once a month²⁸.

Sources for approval dates:⁵. Bevacizumab (Avastin), prepared from the cancer drug, is also widely used off-label, meaning outside its FDA-approved uses, and it worked as well as ranibizumab in a large trial^34,4.

What injections achieve. In the main trials, people treated regularly gained on average about 5 to 11 letters on the eye chart (one to two lines) in the first year^{35,36,37,38,39,40}. Eyes given sham (dummy) injections lost about 10 letters³⁵. Five years after joining a large US trial, half of the treated eyes that were re-examined still saw 20/40 or better on the eye chart (seeing at 20 feet what a typical eye sees at 40 feet). One in five saw 20/200 or worse, and average vision had fallen slightly below where it started⁴¹. In Denmark, new cases of legal blindness from AMD halved between 2000 and 2010, mostly after injections arrived in 2006⁴².

Schedules. Many doctors now use "treat and extend": monthly injections until the retina is dry, then gradually longer intervals for as long as it stays dry; there is no single agreed schedule⁴. Our guide to eye injections for macular degeneration covers what to expect on injection day.

Risks. Serious problems are rare: eye infection (about 1 in 2,000 to 1 in 3,000 injections in US studies)^43,44, raised eye pressure, and rare blood clots such as stroke⁴. Get care right away if, in the days after an injection, your eye becomes more painful or red, is sensitive to light, or your vision gets worse, or if you see new floaters, flashes or a dark curtain. Call your retina practice, or go to an emergency eye service if you cannot reach them^32,4.

Stopping or missing injections. Wet AMD is controlled, not cured, so ongoing follow-up is essential⁴. In one study, eyes whose treatment lapsed for more than six months lost vision that did not come back even after injections resumed⁴⁵. Read what happens if you stop eye injections for macular degeneration and our page on wet AMD treatment and integrative care.

Photodynamic therapy (a light-activated drug, verteporfin) is now much less common, though doctors sometimes add it to injections^28,46. In polypoidal choroidal vasculopathy (PCV), a variant of wet AMD, adding it reduced the number of injections needed⁴.

Treatment for geographic atrophy (late dry AMD)

Two drugs injected into the eye are FDA-approved for geographic atrophy: Syfovre (pegcetacoplan, February 2023) and Izervay (avacincaptad pegol, August 2023)⁵. Both block part of the immune complement system, and both slow the growth of atrophy without improving vision:

• Syfovre slowed lesion growth by about 16% to 22% over two years compared with sham injections⁴⁷. Wet AMD developed in 12% of eyes treated monthly and 7% treated every other month, against 3% with sham⁴⁸. A rare inflammation of the retinal blood vessels (retinal vasculitis), about 1 in 4,000 first injections, can cause severe vision loss^48,4. The European Medicines Agency refused approval in 2024, judging that slower lesion growth did not give patients clinically meaningful benefit⁴⁹.
• Izervay slowed growth by about 14% to 18% in the first year of its main trial, depending on how growth was measured^50,51. Wet AMD developed in 12% of treated eyes against 9% with sham over two years⁵¹. Since February 2025 it can be given monthly without a time limit^51,52.

Neither drug improved vision or reading speed in trials^4,47. Syfovre is injected every 25 to 60 days and Izervay once a month, for as long as treatment continues^48,51. Whether to start is a decision to make with your retina specialist, weighing slower growth against frequent injections and their risks⁴. Our guide to dry macular degeneration treatment compares the options.

Light therapy (photobiomodulation)

In November 2024 the FDA authorised the Valeda light system for dry AMD through its De Novo pathway, which is not the same as drug approval⁵³. It is for people with dry AMD and vision between 20/32 and 20/70, without wet AMD or atrophy in the centre of the macula⁵³. In its trial of 100 people, treated eyes read about 4 letters more than sham-treated eyes at 21 months, which the FDA summarised as about one line after about two years^53,54. The difference at 13 months was not statistically significant in the FDA's analysis, and the FDA described the benefit as "of marginal clinical significance"⁵³. No non-white participants were treated, more treated eyes developed wet AMD, and whether the benefit lasts after treatment stops is unknown⁵³. It is a prescription device, available only through an eye doctor⁵³. Red-light devices sold online for home use are different products.

Low vision rehabilitation

Low vision specialists help people make the most of the vision they have, with magnifiers, bright lighting and electronic reading aids⁴. In a randomised trial in veterans with macular disease, low vision rehabilitation improved people's ability to read and manage everyday tasks, while people on the waiting list declined⁵⁵. Aids help people read more easily, though usually not as well as before AMD⁴. Ask for a referral early rather than late⁵⁵. Our guide to living with macular degeneration has practical strategies.

New treatments for macular degeneration in clinical trials

The aims of current research are fewer injections for wet AMD, and slowing geographic atrophy enough to protect vision. Phase 3 trials are the large, final tests before a company can apply for approval. Trial status is as posted on ClinicalTrials.gov or announced by the companies when checked on October 20, 2026. Some registry records had not been updated for months, so company figures are used where they are newer. Several results are due within months, so this section will change⁵⁶.

Recent setbacks show why results must be awaited. Sozinibercept, an add-on injection, failed two phase 3 trials in 2025^64,56. Danicopan, an oral pill for geographic atrophy, was stopped for lack of effect⁵⁶. A Johnson & Johnson gene therapy for geographic atrophy was dropped in 2026⁶⁵, and oral gildeuretinol missed statistical significance in geographic atrophy⁶⁶. If you are interested in a trial, ask your retina specialist or search ClinicalTrials.gov.

Living with macular degeneration

• Keep every appointment and injection. Wet AMD is controlled, not cured⁴.
• Test each eye at home with an Amsler grid or the device your doctor recommends².
• Stop smoking, the most important change you can make⁴.
• Ask about low vision rehabilitation early⁵⁵.
• Check driving safety with your eye doctor.
• Watch your mood. AMD is linked to depression and reduced quality of life; tell your doctor if you are struggling⁴.
• Reduce fall risk at home with good lighting and contrast; vision loss increases falls⁴.

Where integrative care fits

Netra Eye Institute is an acupuncture and Oriental medicine practice. Nothing we offer replaces AREDS2 vitamins, injections or monitoring by your retina specialist, and macular degeneration care stays with them. Our role is adjunctive: care that sits alongside your specialist's treatment, with the evidence explained before you start. Here is what the research shows for the approaches people ask about most. "Observational" means studies that follow people over time: they can show a link but cannot prove cause.

What working with Netra looks like. We ask first that you have an ophthalmologist or retina specialist managing your AMD, with a clear plan for vitamins, injections and monitoring. If you notice new distortion or a new dark spot, call them first; that comes before anything we do. Then we review your diagnosis, stage and current treatment, and look at the factors around the macula that matter for overall health: smoking, diet, exercise, blood pressure, sleep and stress. We offer acupuncture and, where appropriate, Chinese herbal medicine within Netra Restoration Therapy (NRT), and we check every herb and supplement against your medicines, including blood thinners and your AREDS2 formula. NRT is adjunctive. It does not replace injections or AREDS2 vitamins, and it does not restore lost vision. We do not claim that it slows AMD or geographic atrophy; that is a question only a controlled trial can answer, and no controlled trial of NRT has been done. For the Ayurvedic perspective, see Ayurveda and macular degeneration.

Outlook

Not everyone with AMD develops late AMD or gets it in both eyes¹. Central vision loss is common in late AMD, but AMD does not cause complete blindness, because side vision is spared¹. For people with intermediate AMD, about 18% progressed to late AMD within five years in the original AREDS study: about 6% of those with large drusen in one eye and 26% of those with many large drusen in both eyes. The risk is higher still when pigment changes are present too^4,14. When one eye already has wet AMD, the other eye developed it in about 1 in 6 to 1 in 3 people within two years in recent studies^83,84, which is why home testing and regular visits matter. With wet AMD, outcomes track how well treatment is kept up. In a registry of Australian and New Zealand eyes, the 28% that completed ten years of treatment ended within one letter of their starting vision on average, while eyes that stopped ended below it. Swiss eyes that received fewer injections did worse⁸⁵.

Frequently asked questions

Is there a cure for macular degeneration?

No. Injections control wet AMD and two drugs slow geographic atrophy, but none cures the disease⁴.

Can macular degeneration be reversed?

Not in the sense of repairing the macula. In wet AMD, injections can improve vision, by one to two lines on average in the first year^35,36. In dry AMD, lost retinal cells do not return, and the geographic atrophy drugs slow damage without improving vision⁴. Read more in can macular degeneration be reversed?

Is macular degeneration hereditary?

Partly. A close relative with AMD roughly doubles your risk¹⁸, and common gene variants raise it¹⁹, but age and smoking matter too. Routine genetic testing is not recommended⁴.

What are the first signs of macular degeneration?

Often none at first. As AMD progresses, some people notice mild blurring in the centre of their vision or need more light to read¹. Straight lines that look wavy or bent are a warning sign of late AMD; see your eye doctor right away¹.

Which is worse, wet or dry macular degeneration?

Wet AMD causes faster vision loss and most severe vision loss from AMD^2,4, but it can be treated with injections. Dry AMD progresses slowly, and its late stage, geographic atrophy, can also cause serious central vision loss².

What is the best vitamin for macular degeneration?

For people with intermediate AMD, or late AMD in one eye, the AREDS2 formula lowers the risk of progression⁴. It does not help early AMD or prevent AMD, and smokers and former smokers should avoid formulas containing beta-carotene^22,24.

Will I go blind from macular degeneration?

AMD does not cause complete blindness, because it spares side vision¹. Some people do lose enough central vision to be legally blind (20/200 or worse in the better eye), although in Denmark new cases halved after injections for wet AMD arrived⁴². Keeping up injections for wet AMD protects vision⁸⁵, and low vision rehabilitation helps people use the vision they have⁵⁵.

What happens if I stop my eye injections?

Wet AMD is controlled, not cured, so it can become active again^4,86. Eyes whose treatment lapsed for more than six months lost vision that did not recover when injections restarted⁴⁵. Talk to your retina specialist before changing your schedule.

Can acupuncture, diet or supplements help macular degeneration?

A Mediterranean-style diet, leafy greens, exercise and not smoking are linked to lower risk, and eating fish was linked in some studies^67,20,77,17. Acupuncture has low to very-low certainty evidence from small trials⁷⁰. None of these replaces AREDS2 vitamins or injections. Netra offers acupuncture as adjunctive care alongside your specialist's treatment, with the evidence explained.

Sources

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